Provider Demographics
NPI:1073009403
Name:GROOMS, CHRISTOPHER AARON
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:AARON
Last Name:GROOMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 E 22ND ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4138
Mailing Address - Country:US
Mailing Address - Phone:307-630-9136
Mailing Address - Fax:
Practice Address - Street 1:1745 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4138
Practice Address - Country:US
Practice Address - Phone:307-630-9136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services