Organization
LIFE SKILLS REHABILITATION CENTER, L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GORDON MAX MICKELSON III (PARTNER)
(307) 389-9169
Entity
Organization
Contact information
Practice address
3405 WHITE MOUNTAIN BLVD, ROCK SPRINGS, WY 82901-4729
(307) 362-6029
Mailing address
3405 WHITE MOUNTAIN BLVD, ROCK SPRINGS, WY 82901-4729
(307) 362-6029
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
04/04/2007
Last updated
08/22/2020
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