EASTERN SHOSHONE RECOVERY (NPI# 1265751309) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265751309 |
| Entity Type | Organization |
| Organization Name | EASTERN SHOSHONE RECOVERY |
| Other Organization Name | EASTERN SHOSHONE TRIBE |
| Practice Address |
#7 Shipton Lane Fort Washakie WY 82514-0538 |
| Mailing Address |
Po Box 538 Fort Washakie WY 82514-0538 |
| Practice Telephone | 3073351169 |
| Practice Fax Number | 3073351170 |
| Mailing Telephone | 3073351169 |
| Mailing Fax Number | 3073351170 |
| Enumeration Date | 2010-05-28 |
| Last Update Date | 2016-05-31 |
| Authorized Official Name | KELLIE R WEBB (RECOVERY PROGRAM DIRECTOR) |
| Authorized Official Telephone | 3073351169 |
| Authorized Official Credential | BS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
WY | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | 130744400 | 05 |
| Other Name | Type Code |
|---|---|
| Eastern Shoshone Tribe | Other Name - Individual/Organization |
| Street Address |
#7 SHIPTON LANE |
| City | FORT WASHAKIE |
| State | WY |
| Zip Code | 82514-0538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568810315 | Delane Tidzump | Case Manager/Care Coordinator | #7 Shipton Lane, Fort Washakie, WY 82514-0538 | 2016-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619527819 | Melissa Rose Pine | Registered Nurse | 29 Blackcole Road, Fort Washakie, WY 82514 | 2019-09-19 |
| 1982116794 | Madonna Lee Kienlen | Peer Specialist | 215 Ethete Road, Ft. Washakie, WY 82514 | 2017-11-02 |
| 1649789025 | Rebecca Charlene Willis | Technician, Other | Fort Washakie Healt Center Lab Ihs 29 Black Coal Drive, Fort Washakie, WY 82514 | 2017-09-28 |
| 1033553185 | Pauline Elizabeth Powers-peprah | Family Medicine | 29 Black Cole, Fort Washakie, WY 82514 | 2013-04-19 |
| 1528319373 | Amanda L Schultz | Licensed Practical Nurse | 110 Sharpnose Road, Fort Washakie, WY 82514 | 2012-09-19 |
| 1770898140 | Kelly Lynne Pretty Weasel | Clinic/Center | 29 Blackcole Dr, Fort Washakie, WY 82514 | 2010-08-10 |
| 1285950170 | Debra Kay Waters | Technician, Pathology | Black Coal Rd. Bldg. 29, Ft. Washakie, WY 82514 | 2010-04-16 |
| 1881919751 | Shoshone & Arapaho Tribal Substance Abuse Court | Clinic/Center | 215 Ethete Rd, Fort Washakie, WY 82514 | 2010-04-02 |
| 1770814253 | Christopher G Nelson | Spec/Tech, Pathology | 29 Black Coal Rd, Ft. Washakie, WY 82514 | 2010-01-22 |
| 1922339449 | Nina Williams | Spec/Tech, Pathology | Black Coal Rd Bldg 29, Ft Washakie, WY 82514 | 2010-01-22 |
| Find all providers in zip 82514 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881919751 | Shoshone & Arapaho Tribal Substance Abuse Court | Clinic/Center | 215 Ethete Rd, Fort Washakie, WY 82514 | 2010-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558837682 | Chrysalis Treatment Center, Inc. | Clinic/Center | 137 S Division St, Powell, WY 82435-2409 | 2018-10-16 |
| 1518346709 | High Country Behavioral Health | Clinic/Center | 1050 North Highway 414, Mountain View, WY 82939-0458 | 2015-05-21 |
| 1902213093 | White Buffalo Recovery Center | Clinic/Center | #22 Great Plains Rd, Arapahoe, WY 82510 | 2014-07-21 |
| 1255604856 | High Country Behavioral Health | Clinic/Center | 830 Highway 150 S, Evanston, WY 82930-5341 | 2012-02-14 |
| 1124302005 | Northern Wyoming Mental Health Center, Inc. | Clinic/Center | 420 1/2 Main St, Sundance, WY 82729 | 2011-10-10 |
| 1174805402 | High Country Behavioral Health | Clinic/Center | 190 Overthrust Rd., Evanston, WY 82931-2910 | 2011-09-13 |
| 1891099545 | High Country Behavioral Health | Clinic/Center | 75 Yellow Creek Rd., Ste 105, Evanston, WY 82930-5205 | 2011-01-10 |
| 1578765749 | With Eagle's Wings | Clinic/Center | 11 Great Plain Road, Arapahoe, WY 82524-0197 | 2007-06-01 |
| 1316151053 | Solutions for Life | Clinic/Center | 905 S Main St., Lusk, WY 82225 | 2007-05-10 |
| 1013133198 | Cheyenne Community Drug Abuse Treatment Council, Inc. | Clinic/Center | 1920 Thomes Ave, Suite 320, Cheyenne, WY 82001-3542 | 2007-04-17 |
| Find all providers with the same taxonomy | ||||
| City | FORT WASHAKIE |
| Zip Code | 82514 |
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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.