Magic City Enterprises, Inc | |
1780 Westland Rd Cheyenne WY 82001-3322 | |
(307) 637-8869 | |
(307) 638-0467 |
Full Name | Magic City Enterprises, Inc |
---|---|
Speciality | Day Training, Developmentally Disabled Services |
Location | 1780 Westland Rd, Cheyenne, Wyoming |
Authorized Official Name and Position | Mandy Jane Liley (VICE PRESIDENT OF BUSINESS SERVICES) |
Authorized Official Contact | 3076378869 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Magic City Enterprises, Inc 1780 Westland Rd Cheyenne WY 82001-3322 Ph: (307) 637-8869 | Magic City Enterprises, Inc 1780 Westland Rd Cheyenne WY 82001-3322 Ph: (307) 637-8869 |
NPI Number | 1194895359 |
---|---|
Provider Enumeration Date | 11/08/2006 |
Last Update Date | 09/17/2020 |
Certification Date | 09/17/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1194895359 | NPI | - | NPPES |
100132901 | Medicaid | WY | |
100132911 | Medicaid | WY | |
100132912 | Medicaid | WY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103TC0700X | Psychologist - Clinical | (Wyoming) | Secondary |
251C00000X | Day Training, Developmentally Disabled Services | (Wyoming) | Primary |
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