Provider Demographics
NPI:1689288201
Name:WIND RIVER WRAPAROUND
Entity Type:Organization
Organization Name:WIND RIVER WRAPAROUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:ENOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-349-5647
Mailing Address - Street 1:PO BOX 82
Mailing Address - Street 2:
Mailing Address - City:FORT WASHAKIE
Mailing Address - State:WY
Mailing Address - Zip Code:82514-0082
Mailing Address - Country:US
Mailing Address - Phone:307-349-5647
Mailing Address - Fax:
Practice Address - Street 1:16 SANDHILLS RD.
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-349-5647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health