Organization
ADVANTAGE COMMUNITY SUPPORTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER BLAIR (OWNER)
(419) 618-0366
Entity
Organization
Contact information
Practice address
701 W DALE BLVD, CHEYENNE, WY 82009-5930
(419) 618-0366
Mailing address
701 W DALE BLVD, CHEYENNE, WY 82009-5930
(419) 618-0366
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
02/26/2019
Last updated
02/26/2019
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