NPIMap

Organization Active NPI

State of Wyoming

  • Intellectual Disabilities Intermediate Care Facility
  • Lander, WY
National Provider Identifier
1700949278
Registry record updated Sep 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
100180904 Issued in WY
Legal business name
STATE OF WYOMING
Practice address
8204 Highway 789
Lander, WY 82520
Phone
(307) 335-6700
NPI assigned
Dec 18, 2006
Organization subpart
Yes
Parent organization
STATE OF WYOMINGAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2023

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

Authorized official

Name
Rachel Jones
Title
Accounting Manager
Phone
(307) 335-6756

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 100180904 WY Primary

Addresses

Primary practice location

8204 Highway 789
Lander, WY 82520

Mailing address

8204 Highway 789
Lander, WY 82520
Phone (307) 335-6700

Other identifiers 1

IdentifierTypeStateIssuer
100180904MedicaidWY

Other names 1

  • Wyoming Life Resource Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D0662191Wyoming Life Resource Center8204 Highway 789, Lander, WY 82520Certificate of waiverAug 20, 2026

National Provider Directory

National Provider Directory
Tax ID family
Division of Health Care11 organizations share this tax ID, including this one
Part of
Division of Health Care

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695859200000",
    "number": "1700949278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8204 HIGHWAY 789",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "82520",
            "telephone_number": "307-335-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8204 HIGHWAY 789",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "82520",
            "telephone_number": "307-335-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF WYOMING",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF WYOMING",
        "enumeration_date": "2006-12-18",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A",
        "authorized_official_last_name": "JONES",
        "authorized_official_first_name": "RACHEL",
        "authorized_official_title_or_position": "ACCOUNTING MANAGER",
        "authorized_official_telephone_number": "307-335-6756"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "WY",
            "license": "100180904",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100180904",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wyoming Life Resource Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lander, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.