Provider Demographics
NPI:1659780336
Name:SHOSHONI SENIOR CITIZENS CENTER
Entity Type:Organization
Organization Name:SHOSHONI SENIOR CITIZENS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-876-2703
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:214 E. 2ND
Mailing Address - City:SHOSHONI
Mailing Address - State:WY
Mailing Address - Zip Code:82649-0027
Mailing Address - Country:US
Mailing Address - Phone:307-876-2703
Mailing Address - Fax:307-876-2685
Practice Address - Street 1:214 E. 2ND
Practice Address - Street 2:
Practice Address - City:SHOSHONI
Practice Address - State:WY
Practice Address - Zip Code:82649-0027
Practice Address - Country:US
Practice Address - Phone:307-876-2703
Practice Address - Fax:307-876-2685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY116118100Medicaid