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WYOMING LIFE RESOURCE CENTER

Intermediate Care Facility, Mentally Retarded

Lander, Wyoming

Provider NPI: 1700949278

Organization Information:
Organization Name:  WYOMING LIFE RESOURCE CENTER


Practice Location:
8204 STATE HIGHWAY 789  LANDER, WY 82520 US
Tel: 307-335-6700  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
WY100180901
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
WY100180904

Other Provider Identifiers:

IssuerNumberStateType
100180901WY05
100180904WY05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS WY - Page 1



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