WYOMING LIFE RESOURCE CENTER NPI 1366501561

NPI Information

NPI: 1366501561
Provider Name: WYOMING LIFE RESOURCE CENTER
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization

CLIA Number: 53D0662191

Address:
8204 STATE HIGHWAY 789
LANDER, WY
ZIP 82520
Phone: (307) 335-6700
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WYOMING LIFE RESOURCE CENTER is an intermediate care facility mentally retarded in Lander, WY. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. WYOMING LIFE RESOURCE CENTER NPI is 1366501561. The provider is registered as an organization entity type.

The provider's business location address is:

8204 STATE HIGHWAY 789
LANDER, WY
ZIP 82520-941
Phone: (307) 335-6700
Fax: (307) 335-6764

The provider's authorized official is Kevin Kulow .
The authorized official title is Operations Manager and has the following contact phone number (307) 335-6762.

The CLIA number assigned to this NPI record is 53D0662191 - intermediate care facility for mentally retarded with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/6/2006 and was last updated on 7/28/2008.

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
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		100180900	WYOMING	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100180900	MEDICAID	WYOMING

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: 4/28/2024

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