Provider Demographics
NPI:1437328663
Name:NORTHEAST WYOMING BOCES
Entity Type:Organization
Organization Name:NORTHEAST WYOMING BOCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-682-0231
Mailing Address - Street 1:410 N MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-2929
Mailing Address - Country:US
Mailing Address - Phone:307-682-0231
Mailing Address - Fax:307-686-7628
Practice Address - Street 1:410 N MILLER AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2929
Practice Address - Country:US
Practice Address - Phone:307-682-0231
Practice Address - Fax:307-686-7628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY124322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children