Candice Rae Gronberg, NPI 1356632087
Child Intellectual and/or Developmental Disabilities Respite Care in Lander, WY, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1356632087
NPI Entity Type Individual
Provider Name Candice Rae Gronberg
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Provider Location Address 4 Roberts Road, Lander, WY, US
Provider Mailing Address Po Box 1401, 4 Roberts Road, Lander, WY, US, 825201401
Is Sole Proprietor? Yes
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Primary Taxonomy

Taxonomy Code

385HR2060X

Taxonomy Name Child Intellectual and/or Developmental Disabilities Respite Care
Classification

Respite Care

Group

Respite Care Facility

License No. 114858300
License State WY
Description A facility or distinct part of a facility that provides short term, residential care to children diagnosed with intellectual and/or developmental disabilities as respite for the regular caregivers.

Business Address

Candice Rae Gronberg
4 Roberts Road

Lander, WY, US

Phone: 307-332-9122
Fax: 307-332-9122

Mailing Address

Candice Rae Gronberg
Po Box 1401
4 Roberts Road
Lander, WY, US
ZIP 825201401
Phone: 307-332-9122
Fax: 307-332-9122

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NPI Name Taxonomy Address

1447661319

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Organization

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Jackson Hole Behavioral Services, Llc

Organization

Early Intervention Provider Agency

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