NPI:
1265751309
Provider Name:
EASTERN SHOSHONE RECOVERY
Other Name: EASTERN SHOSHONE TRIBE
Classification:
Clinic/Center - 261QR0405X
Entity Type:
Organization
Specialization: Rehabilitation, Substance Use Disorder
Address:
#7 SHIPTON LANE
FORT WASHAKIE, WY
ZIP 82514
Phone:
(307) 335-1169
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EASTERN SHOSHONE RECOVERY is a rehabilitation and substance use disorder clinic center in Fort Washakie, WY. EASTERN SHOSHONE RECOVERY NPI is 1265751309. The provider is registered as an organization entity type.
The provider Other Name Is Eastern Shoshone Tribe.
The provider's business location address is:
#7 SHIPTON LANE
FORT WASHAKIE, WY
ZIP 82514-538
Phone: (307) 335-1169
Fax: (307) 335-1170
The provider's authorized official is Kellie R Webb .
The authorized official title is Recovery Program Director and has the following contact phone number (307) 335-1169.
The enumeration date for this NPI number is 5/28/2010 and was last updated on 5/31/2016.