S48Wy1, LLC
Organization Active NPI Substance Abuse Rehabilitation Facility · Casper, WY
NPI 1891994950 · NPPES record last updated Jan 14, 2021
Key facts
- NPI
- 1891994950
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Substance Abuse Rehabilitation Facility 324500000X
- Legal business name
- S48WY1, LLC
- Practice address
- 231 S. Wilson
Casper, WY 82601 - Phone
- (307) 265-3791
- Fax
- (307) 265-4480
- NPI assigned
- Jul 17, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Amanda Constantino
- Title
- Provider Enrollment
- Phone
- (307) 265-3791
Other NPIs on the same Medicare enrollment 1
Subparts reporting this organization as parent 3
Practitioners 8
-
Brittany N Cruz, M.S., CAP, PPC
-
Cory Blake Cruz, PPC
-
Kristi Hann, MS, CAP, LPC, NCC
-
Thomas E Radosevich, M.D.
-
Deette Lundberg, LAT
-
Shandra Shepard, NP-C
-
Hanna Powers, PMHNP
-
Shannon Marie Dewitt, CAP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 53D2022866 | S48Wy1 LLC, Dba/Wyoming Recovery | Certificate of waiver | Apr 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150219002493 | WY | Part B Supplier - Clinic/Group Practice | 9436474137 |
Receives reassigned benefits from 7 practitioners 1 other NPI on this enrollment Practice locations: Casper, WY; Rawlins, WY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Substance Abuse Rehabilitation Facility | 324500000X | Yes |
Addresses
Primary practice location
231 S. Wilson
Casper, WY 82601
Mailing address
231 S. Wilson
Casper, WY 82601
Phone (307) 265-3791
Other names
- Wyoming Recovery
Other providers in Casper, WY
- Daniel Bryan Rust
- Zane Rutledge
- Aaron Ray Rutz
- Melodie Marie Ryan-Rose
- Jennifer Leigh Ryerson-Heaton
- Sage Counseling LLC
- Sage Medical Group LLC
- Sage Medical Group LLC
- Maxim Eslao Salva
- Rebecca Leigh Samberg
All providers in Casper, WY · Substance Abuse Rehabilitation Facility in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 14, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.