Provider Demographics
NPI:1093026973
Name:ACCREDITED CASE MANAGEMENT
Entity Type:Organization
Organization Name:ACCREDITED CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:307-267-7224
Mailing Address - Street 1:3440 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-3552
Mailing Address - Country:US
Mailing Address - Phone:307-266-2031
Mailing Address - Fax:307-266-2032
Practice Address - Street 1:3440 E 19TH ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-3552
Practice Address - Country:US
Practice Address - Phone:307-266-2031
Practice Address - Fax:307-266-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-25
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management