National Provider Identifier Database

JCILOA
Substance Abuse Disorder Rehabilitation Facility

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.


Contact Information

JCILOA
1000 ERWIN ST
DOUGLAS, WY82633-2914
Phone: 307-331-3703
Fax:
Website:
Specialty Taxonomy Code
* Substance Abuse Disorder Rehabilitation Facility 324500000X

* Indicates primary specialty

NPI Profile & details for JCILOA

NPI Number 1366108425
Legal business name
LBN
JCILOA
Authorized official EDWARD TUCKER - (OWNER)
Entity Organization
Organization subpart No
Enumeration date 11/12/2021
Last updated 07/02/2022 - About 4 years ago
Sole proprietor1 Not specified
Identifiers n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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