Provider Demographics
NPI:1285088005
Name:THE WEST VILLAGE - YOUTH RANCH
Entity type:Organization
Organization Name:THE WEST VILLAGE - YOUTH RANCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:SNEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-685-3670
Mailing Address - Street 1:PO BOX 3917
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82717-3917
Mailing Address - Country:US
Mailing Address - Phone:307-685-3670
Mailing Address - Fax:
Practice Address - Street 1:203 CAREY AVE
Practice Address - Street 2:# 5
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3813
Practice Address - Country:US
Practice Address - Phone:307-685-3670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty