Provider Demographics
NPI:1417001330
Name:VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity Type:Organization
Organization Name:VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF IT AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-672-0475
Mailing Address - Street 1:420 DEANNE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2936
Mailing Address - Country:US
Mailing Address - Phone:307-746-4456
Mailing Address - Fax:307-746-4470
Practice Address - Street 1:420 DEANNE AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2936
Practice Address - Country:US
Practice Address - Phone:307-746-4456
Practice Address - Fax:307-746-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY01032001OtherBCBS
WY106074106Medicaid
WY106074100Medicaid