ICBM INC (NPI# 1205369576) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205369576 |
| Entity Type | Organization |
| Organization Name | ICBM INC |
| Other Organization Name | ARC OF WYOMING |
| Practice Address |
1501 Red Tail Dr Rock Springs WY 82901-5879 |
| Mailing Address |
126 Elk St Rock Springs WY 82901-5241 |
| Practice Telephone | 3073626029 |
| Practice Fax Number | 3073622379 |
| Mailing Telephone | 3073626029 |
| Mailing Fax Number | 3073622379 |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2017-04-04 |
| Authorized Official Name | DR. ELINA CHERNYAK (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 9703062737 |
| Authorized Official Credential | DO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | Residential Treatment Facilities |
| Other Name | Type Code |
|---|---|
| ARC of Wyoming | Doing Business As Name - Organization |
| Street Address |
1501 RED TAIL DR |
| City | ROCK SPRINGS |
| State | WY |
| Zip Code | 82901-5879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598092413 | Joshua Robert Bellamy | Case Manager/Care Coordinator | 1501 Red Tail Dr, Rock Springs, WY 82901-5879 | 2009-11-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568094043 | Carol Mary Iverson | Naturopath | 120 Winston Dr., Ste. 101, Rock Springs, WY 82901 | 2020-02-12 |
| 1366098691 | Nolan Jeffres | Dentist | 1151 Gateway Blvd, Suite 102, Rock Springs, WY 82901 | 2019-08-13 |
| 1588149181 | Ali Pendleton | Case Manager/Care Coordinator | 79 Winston #235, Rock Springs, WY 82901 | 2018-09-28 |
| 1982142014 | Tammy Fausett | Speech-Language Pathologist | 1105 Applewood Drive, Rock Springs, WY 82901 | 2017-02-09 |
| 1649713983 | Lori Lee Cunningham | Case Manager/Care Coordinator | 325 Archers Trl, Rock Springs, WY 82901 | 2016-11-18 |
| 1841664505 | Theresa Morrison | Case Manager/Care Coordinator | 308 Peak Road, Rock Springs, WY 82901 | 2015-11-18 |
| 1811376478 | Aspen Mountain Medical Center LLC | General Acute Care Hospital | 4401 College Ave, Rock Springs, WY 82901 | 2015-05-28 |
| 1487931416 | Stephanie Lee Dupree | Nurse Practitioner | 1204 Hilltop Dr. #107 & #108, Rock Springs, WY 82901 | 2011-11-04 |
| 1114201845 | Cowboy Urgent Care, Inc | General Practice | 1453-a Dewar Drive, Rock Springs, WY 82901 | 2011-09-29 |
| 1649564931 | Guardian Flight Inc | Ambulance | 1208 Hilltop Drive, Suite 203, Rock Springs, WY 82901 | 2011-06-03 |
| Find all providers in zip 82901 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse 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. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023285962 | Thad's House, LLC | Substance Abuse Rehabilitation Facility | 636 E A St, Casper, WY 82601-2004 | 2008-05-09 |
| 1891994950 | S48wy1, LLC | Substance Abuse Rehabilitation Facility | 231 S. Wilson, Casper, WY 82601 | 2007-07-17 |
| City | ROCK SPRINGS |
| Zip Code | 82901 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.