Organization Name: | COMMUNITY ACTION OF LARAMIE COUNTY |
NPI Number: | 1043436983 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MELISSA A IPSER (PROGRAM MANAGER) |
Mailing Address: | 100 Central Ave Ste 100 Cheyenne |
State: | WY US |
Postal Code: | 820071330 |
Phone Number: | 3076328064 |
Fax Number: | 3076326131 |
NPI Enumeration Date: | 04/18/2007 |
NPI Last Update Date: | 08/27/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | 20234.0234 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |