Organization
RENEW
Active
Organization
RENEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANDY THIEL (VICE PRESIDENT)
(307) 672-7481
Entity
Organization
Contact information
Practice address
1969 S SHERIDAN AVE, SHERIDAN, WY 82801-6108
(307) 672-7481
(307) 674-5117
Mailing address
1969 S SHERIDAN AVE, SHERIDAN, WY 82801-6108
(307) 672-7481
(307) 674-5117
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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