Provider Demographics
NPI:1932337714
Name:LIANE P MCILWAINE
Entity Type:Organization
Organization Name:LIANE P MCILWAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:PALISOUL
Authorized Official - Last Name:MCILWAINE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:307-632-8911
Mailing Address - Street 1:3719 DOVER RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1606
Mailing Address - Country:US
Mailing Address - Phone:307-632-8911
Mailing Address - Fax:307-433-0487
Practice Address - Street 1:3719 DOVER RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1606
Practice Address - Country:US
Practice Address - Phone:307-632-8911
Practice Address - Fax:307-433-0487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services