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ICBM INC NPI 1205369576


NPI Information

NPI: 1205369576
Provider Name: ICBM INC

Doing Business As: ARC OF WYOMING

Classification: Substance Abuse Rehabilitation Facility - 324500000X
Entity Type: Organization
Address:
1501 RED TAIL DR
ROCK SPRINGS, WY
ZIP 82901
Phone: (307) 362-6029
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ICBM INC is a substance abuse rehabilitation facility in Rock Springs, WY. The provider is a facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. ICBM INC NPI is 1205369576. The provider is registered as an organization entity type.
The provider Is Doing Business As Arc Of Wyoming.

The provider's business location address is:

1501 RED TAIL DR
ROCK SPRINGS, WY
ZIP 82901-879
Phone: (307) 362-6029
Fax: (307) 362-2379

The provider's authorized official is Elina Chernyak .
The authorized official title is Medical Director and has the following contact phone number (970) 306-2737.

The enumeration date for this NPI number is 4/4/2017 and was last updated on 4/4/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1324500000XSubstance Abuse Rehabilitation FacilityYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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