Provider Demographics
NPI:1639389281
Name:CHILD DEVELOPMENT SERVICES OF FREMONT COUNTY, INC.
Entity Type:Organization
Organization Name:CHILD DEVELOPMENT SERVICES OF FREMONT COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEONARDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-332-5508
Mailing Address - Street 1:100 PUSH ROOT CT
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3460
Mailing Address - Country:US
Mailing Address - Phone:307-332-5508
Mailing Address - Fax:307-332-7972
Practice Address - Street 1:100 PUSH ROOT CT
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3460
Practice Address - Country:US
Practice Address - Phone:307-332-5508
Practice Address - Fax:307-332-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center