Provider Demographics
NPI:1801088497
Name:CHILDREN'S DEVELOPMENTAL SERVICES OF CAMPBELL COUNTY
Entity type:Organization
Organization Name:CHILDREN'S DEVELOPMENTAL SERVICES OF CAMPBELL COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-682-2392
Mailing Address - Street 1:1801 S 4J RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5201
Mailing Address - Country:US
Mailing Address - Phone:307-682-2392
Mailing Address - Fax:307-682-8463
Practice Address - Street 1:1801 S 4J RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-5201
Practice Address - Country:US
Practice Address - Phone:307-682-2392
Practice Address - Fax:307-682-8463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center