Provider Demographics
NPI:1427301969
Name:NORTHWEST COMMUNITY ACTION PROGRAMS OF WYOMING, INC.
Entity type:Organization
Organization Name:NORTHWEST COMMUNITY ACTION PROGRAMS OF WYOMING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-347-6185
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-0158
Mailing Address - Country:US
Mailing Address - Phone:307-347-6185
Mailing Address - Fax:307-347-4008
Practice Address - Street 1:500 15 MILE RD
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-9706
Practice Address - Country:US
Practice Address - Phone:307-347-6185
Practice Address - Fax:307-347-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization