Organization
WYOMING LIFE RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN KULOW (OPERATIONS MANAGER)
(307) 335-6762
Entity
Organization
Contact information
Practice address
8204 STATE HIGHWAY 789, LANDER, WY 82520-2941
(307) 335-6700
(307) 335-6764
Mailing address
8204 STATE HIGHWAY 789, LANDER, WY 82520-2941
(307) 335-6700
(307) 335-6764
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
100180900
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100180900
—
WY
Enumeration date
12/06/2006
Last updated
07/17/2025
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