Icbm INC
NPI #1205369576 in Rock Springs, Wyoming
Provider Information
- NPI Number
- 1205369576
- Entity Type
- Organization
- Organization Name
- Icbm INC
- Primary Specialty
- Substance Abuse Rehabilitation Facility
- Enumeration Date
- Apr 4, 2017
- Last Updated
- Apr 4, 2017
Practice Location
- Address
- 1501 RED TAIL DR
- City
- Rock Springs
- State
- Wyoming
- ZIP Code
- 82901-5879
- Phone
- (307) 362-6029
Authorized Official
- Name
- DR. ELINA CHERNYAK, DO
- Title
- MEDICAL DIRECTOR
- Phone
- (970) 306-2737
Specialties & Taxonomy Codes
| Specialty |
|---|
| Substance Abuse Rehabilitation Facility |
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