Organization
S48WY1, LLC
Active
Other names
Wyoming Recovery
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AMANDA CONSTANTINO (PROVIDER ENROLLMENT)
(307) 265-3791
Entity
Organization
Contact information
Practice address
231 S. WILSON, CASPER, WY 82601
(307) 265-3791
(307) 265-4480
Mailing address
231 S. WILSON, CASPER, WY 82601
(307) 265-3791
(307) 265-4480
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/17/2007
Last updated
01/14/2021
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