NPI 1801159447

Region V Boces

Organisation Emotionally Disturbed Childrens' Residential Treatment Facility Wilson, WY

Practice location

Address: 3850 North Wilderness Drive, Wilson, WY 83014-0240
Phone: (307) 733-8210
Fax: (307) 733-8462
Mailing address: PO Box 240, Wilson, WY 83014-0240

Authorised official

Name: Maurice Keith Mader
Title: School and Clinical Social Worker
Phone: (307) 733-8210

Registered specialties

Emotionally Disturbed Childrens' Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 322D00000X Licence LCSW-291 (WY)

Other Residential Treatment Facility, Emotionally Disturbed Children providers in Wyoming →

Registry record

NPI: 1801159447
Entity type: Organization
NPI issued: 19 Jun 2012
Record last updated: 19 Jun 2012

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.