Provider Demographics
NPI:1841481603
Name:YOUTH CRISIS CENTER, INC.
Entity type:Organization
Organization Name:YOUTH CRISIS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DRESANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-577-5718
Mailing Address - Street 1:915 S MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-3440
Mailing Address - Country:US
Mailing Address - Phone:307-577-5718
Mailing Address - Fax:307-577-5716
Practice Address - Street 1:915 S MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-3440
Practice Address - Country:US
Practice Address - Phone:307-577-5718
Practice Address - Fax:307-577-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY115135500Medicaid