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WYOMING LIFE RESOURCE CENTER

Intermediate Care Facility, Mentally Retarded

(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.

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Contact Information

WYOMING LIFE RESOURCE CENTER
8204 STATE HIGHWAY 789
LANDER, WY  82520-2941
 Phone: 307-335-6700
 Fax: 307-335-6764
 Website:
 

Specialty

 Taxonomy Code Specialty Code Provider Type

Intermediate Care Facility, Mentally Retarded

 315P00000X
Indicates primary specialty

NPI Profile & details for WYOMING LIFE RESOURCE CENTER

NPI # 1366501561
LBN Legal business name WYOMING LIFE RESOURCE CENTER
Authorized official KEVIN KULOW - (OPERATIONS MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 12/06/2006
Last updated 07/17/2025 - About 11 months ago
Identifiers
WY License # 100180900
WY Medicaid 100180900
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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