Provider Demographics
NPI:1801159447
Name:REGION V BOCES
Entity type:Organization
Organization Name:REGION V BOCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL AND CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:MADER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW/LCSW
Authorized Official - Phone:307-733-8210
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:WY
Mailing Address - Zip Code:83014-0240
Mailing Address - Country:US
Mailing Address - Phone:307-733-8210
Mailing Address - Fax:307-733-8462
Practice Address - Street 1:3850 NORTH WILDERNESS DRIVE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:WY
Practice Address - Zip Code:83014-0240
Practice Address - Country:US
Practice Address - Phone:307-733-8210
Practice Address - Fax:307-733-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-291322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children