Provider Demographics
NPI:1770692857
Name:SERVICES FOR SENIORS PROGRAM, INC
Entity type:Organization
Organization Name:SERVICES FOR SENIORS PROGRAM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANNE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:HENSEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-322-3424
Mailing Address - Street 1:P.O. BOX 283
Mailing Address - Street 2:
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201
Mailing Address - Country:US
Mailing Address - Phone:307-322-3424
Mailing Address - Fax:307-322-4625
Practice Address - Street 1:1605 16TH STREET
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201
Practice Address - Country:US
Practice Address - Phone:307-322-3424
Practice Address - Fax:307-322-4625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251K00000XAgenciesPublic Health or Welfare
No347B00000XTransportation ServicesBus
No332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY111504900Medicaid
WYW9793Medicare PIN