Provider Demographics
NPI:1770688871
Name:CHILDREN'S RESOURCE CENTER
Entity Type:Organization
Organization Name:CHILDREN'S RESOURCE CENTER
Other - Org Name:SPECIAL TOUCH PRESCHOOL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAID SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-587-1331
Mailing Address - Street 1:1302 BECK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3758
Mailing Address - Country:US
Mailing Address - Phone:307-587-1331
Mailing Address - Fax:307-587-1661
Practice Address - Street 1:1302 BECK AVE STE B
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3758
Practice Address - Country:US
Practice Address - Phone:307-587-1331
Practice Address - Fax:307-587-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY235Z00000X235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106241700Medicaid