Provider Demographics
NPI:1235751389
Name:B.A.C.A. CASE MANAGMENT LLC
Entity Type:Organization
Organization Name:B.A.C.A. CASE MANAGMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACA
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:307-757-5868
Mailing Address - Street 1:6500 LONGABAUGH WAY
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-9699
Mailing Address - Country:US
Mailing Address - Phone:307-757-5868
Mailing Address - Fax:866-544-1882
Practice Address - Street 1:6500 LONGABAUGH WAY
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-9699
Practice Address - Country:US
Practice Address - Phone:307-757-5868
Practice Address - Fax:866-544-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1023499027Medicaid
WY141785100Medicaid