Organization
EARLY INTERVENTION PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH J. SMITH JR. (BUSINESS MANAGER)
(307) 332-3516
Entity
Organization
Contact information
Practice address
9 FORT WASHAKIE SCHOOL RD, FORT WASHAKIE, WY 82514-9601
(307) 332-3516
(307) 332-9116
Mailing address
9 FORT WASHAKIE SCHOOL RD, FORT WASHAKIE, WY 82514-9601
(307) 332-3516
(307) 332-9116
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
12/18/2009
Last updated
12/18/2009
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