WYOMING LIFE RESOURCE CENTER
Intermediate Care Facility, Mentally Retarded
Lander, Wyoming
Provider NPI: 1366501561
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:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
8204 STATE HIGHWAY 789 LANDER, WY 82520 US
Tel: 307-335-6700 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 315P00000X | Nursing & Custodial Care Facilities Intermediate Care Facility, Mentally Retarded | WY | 100180900 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
100180900 | WY | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin