Provider Demographics
NPI: | 1003301904 |
---|---|
Name: | CATHEDRAL HOME FOR CHILDREN |
Entity Type: | Organization |
Organization Name: | CATHEDRAL HOME FOR CHILDREN |
Other - Org Name: | CATHEDRAL HOME FOR CHILDREN |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NICOLE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HAUSER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSW, LCSW |
Authorized Official - Phone: | 307-745-8997 |
Mailing Address - Street 1: | 4989 N 3RD ST |
Mailing Address - Street 2: | |
Mailing Address - City: | LARAMIE |
Mailing Address - State: | WY |
Mailing Address - Zip Code: | 82072-9548 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 307-745-8997 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 4989 N 3RD ST |
Practice Address - Street 2: | |
Practice Address - City: | LARAMIE |
Practice Address - State: | WY |
Practice Address - Zip Code: | 82072-9548 |
Practice Address - Country: | US |
Practice Address - Phone: | 307-745-8997 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2018-06-25 |
Last Update Date: | 2023-06-09 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 323P00000X | Residential Treatment Facilities | Psychiatric Residential Treatment Facility | ||
No | 101Y00000X | Behavioral Health & Social Service Providers | Counselor | Group - Multi-Specialty | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
No | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |
No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | ||
No | 3245S0500X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NE | 10026747700 | Medicaid | |
WY | 83-069092 | Medicaid |