Provider Demographics
NPI:1366656522
Name:I-REACH 2 INC
Entity Type:Organization
Organization Name:I-REACH 2 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:307-265-8086
Mailing Address - Street 1:PO BOX 1060
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:WY
Mailing Address - Zip Code:82636-1060
Mailing Address - Country:US
Mailing Address - Phone:307-265-8086
Mailing Address - Fax:307-473-5588
Practice Address - Street 1:351 N LENNOX ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2259
Practice Address - Country:US
Practice Address - Phone:307-265-8086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY117300600Medicaid