Region V Boces

Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Wilson, WY

NPI 1801159447 · NPPES record last updated Jun 19, 2012

Key facts

NPI
1801159447
Entity type
Organization (NPI type 2)
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
License
LCSW-291 (WY)
Legal business name
REGION V BOCES
Practice address
3850 North Wilderness Drive
Wilson, WY 83014-0240
Phone
(307) 733-8210
Fax
(307) 733-8462
NPI assigned
Jun 19, 2012
Organization subpart
No

Authorized official

Name
Mr. Maurice Keith Mader, M.S.W./L.C.S.W.
Title
School and Clinical Social Worker
Phone
(307) 733-8210

Corporate family (same tax ID) 2

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

National Provider Directory

Tax ID family
C-V Ranch (3 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X LCSW-291 WY Yes

Addresses

Primary practice location

3850 North Wilderness Drive
Wilson, WY 83014-0240

Mailing address

PO Box 240
Wilson, WY 83014-0240
Phone (307) 733-8210

Other providers in Wilson, WY

All providers in Wilson, WY · Emotionally Disturbed Childrens' Residential Treatment Facility in Wyoming

Sources for this page

Verify at the official NPI Registry.