Provider Demographics
NPI:1912047184
Name:EPPSON CENTER FOR SENIORS, INC.
Entity Type:Organization
Organization Name:EPPSON CENTER FOR SENIORS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-745-5116
Mailing Address - Street 1:1560 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82072-2014
Mailing Address - Country:US
Mailing Address - Phone:307-745-5116
Mailing Address - Fax:307-742-8669
Practice Address - Street 1:1560 N 3RD ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-2014
Practice Address - Country:US
Practice Address - Phone:307-745-5116
Practice Address - Fax:307-742-8669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management