Organization
VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY BUCKINGHAM (VP OF IT AND COMPLIANCE)
(307) 672-0475
Entity
Organization
Contact information
Practice address
521 W LOTT ST, BUFFALO, WY 82834-1642
(307) 684-5531
(307) 684-2912
Mailing address
521 W LOTT ST, BUFFALO, WY 82834-1642
(307) 684-5531
(307) 684-2912
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00718001
BCBS
WY
05
—
106072406
—
WY
01
—
W4370109
MEDICARE ID PTAN
WY
Enumeration date
01/22/2007
Last updated
04/01/2023
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