Provider Demographics
NPI:1114156536
Name:MOUNTAIN REGIONAL SERVICES, INC.
Entity Type:Organization
Organization Name:MOUNTAIN REGIONAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DATTERI
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:307-789-3710
Mailing Address - Street 1:PO BOX 6005
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-6005
Mailing Address - Country:US
Mailing Address - Phone:307-789-3710
Mailing Address - Fax:307-789-0823
Practice Address - Street 1:50 ALLEGIANCE CIR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3804
Practice Address - Country:US
Practice Address - Phone:307-789-3710
Practice Address - Fax:307-789-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services