NPIMap

Organization Active NPI

Magic City Enterprises

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Cheyenne, WY
National Provider Identifier
1457744724
Registry record updated Mar 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X
License
1194895359 Issued in WY
Legal business name
MAGIC CITY ENTERPRISES
Practice address
1780 Westland Rd
Cheyenne, WY 82001-3322
Phone
(307) 637-8869
Fax
(307) 638-0467
NPI assigned
Mar 11, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2015

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

Authorized official

Name
Mandy Liley
Title
Business Manager
Phone
(307) 637-8869

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 1194895359 WY
Intellectual and/or Developmental Disabilities Residential Treatment Facility 320600000X 1194895359 WY Primary
Physical Disabilities Residential Treatment Facility 320700000X 1194895359 WY

Addresses

Primary practice location

1780 Westland Rd
Cheyenne, WY 82001-3322

Mailing address

1780 Westland Rd
Cheyenne, WY 82001-3322
Phone (307) 637-8869

Other identifiers 2

IdentifierTypeStateIssuer
1194895359MedicaidWY
W21288OtherWYMEDICARE PTAN

National Provider Directory

National Provider Directory
Tax ID family
Magic City Enterprises4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1426032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1457744724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1780 WESTLAND RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013322",
            "telephone_number": "307-637-8869",
            "fax_number": "307-638-4467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 WESTLAND RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013322",
            "telephone_number": "307-637-8869",
            "fax_number": "307-638-0467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGIC CITY ENTERPRISES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-11",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "LILEY",
        "authorized_official_first_name": "MANDY",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "307-637-8869"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "WY",
            "license": "1194895359",
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WY",
            "license": "1194895359",
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "WY",
            "license": "1194895359",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194895359",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "W21288",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; 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.