Provider Demographics
NPI:1083740369
Name:DEVELOPMENTAL PRESCHOOL AND DAY CARE CENTER
Entity Type:Organization
Organization Name:DEVELOPMENTAL PRESCHOOL AND DAY CARE CENTER
Other - Org Name:DEVELOPMENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-742-3571
Mailing Address - Street 1:1771 CENTENNIAL DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070
Mailing Address - Country:US
Mailing Address - Phone:307-742-3571
Mailing Address - Fax:307-742-6397
Practice Address - Street 1:1771 CENTENNIAL DRIVE
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070
Practice Address - Country:US
Practice Address - Phone:307-742-3571
Practice Address - Fax:307-742-6397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106155100Medicaid
WY106155111Medicaid