Provider Demographics
NPI:1376688580
Name:ST. JOSEPH'S CHILDREN'S HOME
Entity Type:Organization
Organization Name:ST. JOSEPH'S CHILDREN'S HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-532-4197
Mailing Address - Street 1:1419 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-3340
Mailing Address - Country:US
Mailing Address - Phone:307-532-4197
Mailing Address - Fax:307-532-8405
Practice Address - Street 1:1419 MAIN ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3340
Practice Address - Country:US
Practice Address - Phone:307-532-4197
Practice Address - Fax:307-532-8405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY5405 I322D00000X
WY5405I323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY111833101Medicaid
OK200051290 AMedicaid
WY111833103Medicaid
WY111833104Medicaid
WY111833105Medicaid
WY111833101Medicaid