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 | 251C00000X | Day Training, Developmentally Disabled Services | | | | No |
| 2 | 251J00000X | Nursing Care | | | | No |
| 3 | 261QA0600X | Clinic/Center | Adult Day Care | | | No |
| 4 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 5 | 310500000X | Intermediate Care Facility, Mental Illness | | | | No |
| 6 | 311ZA0620X | Custodial Care Facility | Adult Care Home | | | No |
| 7 | 314000000X | Skilled Nursing Facility | | | | No |
| 8 | 343900000X | Non-emergency Medical Transport (VAN) | | | | No |
| 9 | 385H00000X | Respite Care | | | | No |
| 10 | 385HR2050X | Respite Care | Respite Care Camp | | | No |
| 11 | 385HR2055X | Respite Care | Respite Care, Mental Illness, Child | | | No |
| 12 | 385HR2060X | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities | | | No |
| 13 | 385HR2065X | Respite Care | Respite Care, Physical Disabilities, Child | | | No |
| 14 | 3104A0625X | Assisted Living Facility | Assisted Living, Mental Illness | | | 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 | 92151784 | MEDICAID | WYOMING | |
