Provider Demographics
NPI:1629294228
Name:JEFFREY C. WARDLE ACADEMY, INC
Entity Type:Organization
Organization Name:JEFFREY C. WARDLE ACADEMY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-638-4092
Mailing Address - Street 1:3304 I80 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-8781
Mailing Address - Country:US
Mailing Address - Phone:307-633-8040
Mailing Address - Fax:307-634-9936
Practice Address - Street 1:3304 I80 SERVICE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-8781
Practice Address - Country:US
Practice Address - Phone:307-633-8040
Practice Address - Fax:307-634-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Not Answered3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children