Boys & Girls Club of Evanston

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

Legal business name

BOYS & GIRLS CLUB OF EVANSTON

Practice address

419 4TH St
Evanston, WY 82930-3616

Phone

(307) 444-2582

NPI assigned

Feb 19, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Holly Slade

Title

Ceo

Phone

(307) 444-2582

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alicia Burton

  • Case Manager/Care Coordinator
  • Evanston, WY
  • NPI 1376903104
  NPD (past)
• Emileigh Hillstead

  • Peer Specialist
  • Evanston, WY
  • NPI 1316310105
  NPD (past)
• Caitlin Holmes

  • Case Manager/Care Coordinator
  • Evanston, WY
  • NPI 1831558741
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455840000000",
    "number": "1073972972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 4TH ST",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829303616",
            "telephone_number": "307-444-2582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 4TH ST",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829303616",
            "telephone_number": "307-444-2582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYS & GIRLS CLUB OF EVANSTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-19",
        "last_updated": "2016-02-19",
        "status": "A",
        "authorized_official_last_name": "SLADE",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-444-2582"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Hansen Boal, LAT, NCACII, BSW
• Jessica Bond, RN
• Kortney Booth Clark, CASE MANAGEMENT
• Ashleigh Choi Bott, PSY.D.
• William Bruce Bourland, OD
• Coreena J Bradley, LPN
• William Marcus Brann, MD
• Brhall
• Bridges Habilitation Services Inc.
• Bridges Habilitation Services Inc.

• Case Management Agency in Evanston, WY
• Providers in Evanston, WY by specialty
• Case Management Agency in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.