Organization
HUMBLE BEGINNINGS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES ERNEST EDWARD MOORE (CO-FOUNDER/CEO)
(719) 580-8810
Entity
Organization
Contact information
Practice address
6606 WILDERNESS TRL, CHEYENNE, WY 82001-6180
(719) 580-8810
Mailing address
6606 WILDERNESS TRL, CHEYENNE, WY 82001-6180
(719) 580-8810
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Enumeration date
01/10/2019
Last updated
01/10/2019
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