Provider Demographics
NPI:1205011939
Name:JUVENILE EXTENSIVE MANAGEMENT SERVICES
Entity type:Organization
Organization Name:JUVENILE EXTENSIVE MANAGEMENT SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLIFTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-634-7232
Mailing Address - Street 1:117 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-1333
Mailing Address - Country:US
Mailing Address - Phone:307-634-7232
Mailing Address - Fax:
Practice Address - Street 1:117 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82007-1333
Practice Address - Country:US
Practice Address - Phone:307-634-7232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management