Organization
CLOUD PEAK INITIATIVES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY MELVIN SMALL MPA (OFFICE MANAGER)
(307) 674-1668
Entity
Organization
Contact information
Practice address
151 W BRUNDAGE ST, SHERIDAN, WY 82801-4217
(307) 674-1668
Mailing address
151 W BRUNDAGE ST, SHERIDAN, WY 82801-4217
(307) 674-1668
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
ML-2011-017
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1740318013
NPI #
WY
Enumeration date
10/25/2011
Last updated
10/25/2011
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