| 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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