Organization
STATE OF WYOMING
Active
Parent organization
STATE OF WYOMING
Other names
Wyoming Life Resource Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF WYOMING
Authorized official
RACHEL JONES (ACCOUNTING MANAGER)
(307) 335-6756
Entity
Organization
Contact information
Practice address
8204 HIGHWAY 789, LANDER, WY 82520
(307) 335-6700
Mailing address
8204 HIGHWAY 789, LANDER, WY 82520
(307) 335-6700
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
100180904
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100180904
—
WY
Enumeration date
12/18/2006
Last updated
09/28/2023
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