Provider Demographics
NPI:1073753752
Name:VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF IT AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-672-0475
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-1005
Mailing Address - Country:US
Mailing Address - Phone:307-426-4727
Mailing Address - Fax:307-426-4681
Practice Address - Street 1:1954 W MARIPOSA PKWY
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3102
Practice Address - Country:US
Practice Address - Phone:307-322-3190
Practice Address - Fax:307-322-3198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY301052OtherBS
WY106079105Medicaid
WYW301052Medicare PIN