Provider Demographics
NPI:1932643467
Name:TEHLA BATES STAYER DBA TREASURE ABILITIES CASE MANAGEMENT SERVICES
Entity Type:Organization
Organization Name:TEHLA BATES STAYER DBA TREASURE ABILITIES CASE MANAGEMENT SERVICES
Other - Org Name:TREASURE ABILITIES CASE MANAGEMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TEHLA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BATES STAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-421-2465
Mailing Address - Street 1:1111 E LINCOLNWAY
Mailing Address - Street 2:SUITE #109
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4848
Mailing Address - Country:US
Mailing Address - Phone:307-421-2465
Mailing Address - Fax:
Practice Address - Street 1:1111 E LINCOLNWAY
Practice Address - Street 2:SUITE #109
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4848
Practice Address - Country:US
Practice Address - Phone:307-421-2465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY142757100Medicaid