1124302005 NPI number — VOLUNTEERS OF AMERICA NORTHERN ROCKIES

Table of content: (NPI 1124302005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124302005 NPI number — VOLUNTEERS OF AMERICA NORTHERN ROCKIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124302005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
521 W LOTT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82834-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-751-7440
Provider Business Mailing Address Fax Number:
307-283-2898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 1/2 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNDANCE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-283-3636
Provider Business Practice Location Address Fax Number:
307-283-2898
Provider Enumeration Date:
10/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BUCKINGHAM
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF IT AND COMPLIANCE
Authorized Official Telephone Number:
307-684-5531

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 106076707 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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