Provider Demographics
NPI:1841558707
Name:PINE BLUFFS SENIOR CENTER, INC
Entity Type:Organization
Organization Name:PINE BLUFFS SENIOR CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-245-3816
Mailing Address - Street 1:309 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFFS
Mailing Address - State:WY
Mailing Address - Zip Code:82082-0532
Mailing Address - Country:US
Mailing Address - Phone:307-245-3816
Mailing Address - Fax:307-245-3587
Practice Address - Street 1:309 ELM STREET
Practice Address - Street 2:
Practice Address - City:PINE BLUFFS
Practice Address - State:WY
Practice Address - Zip Code:82082-0532
Practice Address - Country:US
Practice Address - Phone:307-245-3816
Practice Address - Fax:307-245-3587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management