Provider Demographics
NPI:1386798239
Name:VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Entity type:Organization
Organization Name:VOLUNTEERS OF AMERICA NORTHERN ROCKIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF IT AND COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-672-0475
Mailing Address - Street 1:521 W LOTT ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WY
Mailing Address - Zip Code:82834-1642
Mailing Address - Country:US
Mailing Address - Phone:307-684-5531
Mailing Address - Fax:307-684-2912
Practice Address - Street 1:521 W LOTT ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:WY
Practice Address - Zip Code:82834-1642
Practice Address - Country:US
Practice Address - Phone:307-684-5531
Practice Address - Fax:307-684-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW4370109OtherMEDICARE ID PTAN
WY00718001OtherBCBS
WY106072406Medicaid
WY00718001OtherBCBS
WY106072404Medicaid