Active NPI
Alfredo Antillon
- Developmentally Disabled Services Day Training Agency
- Green River, WY
National Provider Identifier
1538366505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmentally Disabled Services Day Training Agency
- Practice address
- 720 Wind River Dr
B
Green River, WY 82935-5725 - Phone
- (307) 875-5781
- NPI assigned
- Jul 2, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | NU | Primary |
Addresses
Primary practice location
720 Wind River Dr
B
Green River, WY 82935-5725
Mailing address
720 Wind River Dr
B
Green River, WY 82935-5725
Phone (307) 875-5781
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538366505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 WIND RIVER DR",
"address_2": "B",
"city": "GREEN RIVER",
"state": "WY",
"postal_code": "829355725",
"telephone_number": "307-875-5781"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 WIND RIVER DR",
"address_2": "B",
"city": "GREEN RIVER",
"state": "WY",
"postal_code": "829355725",
"telephone_number": "307-875-5781"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTILLON",
"first_name": "ALFREDO",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-07-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green River, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.