NPI 1205369576
Icbm INC
Practice location
- Address
- 1501 Red Tail Dr, Rock Springs, WY 82901-5879
- Phone
- (307) 362-6029
- Fax
- (307) 362-2379
- Mailing address
- 126 Elk St, Rock Springs, WY 82901-5241
Authorised official
- Name
- Elina Chernyak
- Title
- Medical Director
- Phone
- (970) 306-2737
Registered specialties
Substance Abuse Rehabilitation Facility
Primary
Registry record
- NPI
- 1205369576
- Entity type
- Organization
- NPI issued
- 4 Apr 2017
- Record last updated
- 4 Apr 2017
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.