Provider Demographics
NPI:1821638685
Name:WYOMING SERVICES FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:WYOMING SERVICES FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUERGENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-250-7233
Mailing Address - Street 1:1156 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LANDER
Mailing Address - State:WY
Mailing Address - Zip Code:82520-3905
Mailing Address - Country:US
Mailing Address - Phone:302-332-4889
Mailing Address - Fax:307-332-2491
Practice Address - Street 1:1156 S 2ND ST
Practice Address - Street 2:
Practice Address - City:LANDER
Practice Address - State:WY
Practice Address - Zip Code:82520-3905
Practice Address - Country:US
Practice Address - Phone:307-332-4889
Practice Address - Fax:307-332-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management