Provider Demographics
| NPI: | 1477438620 |
|---|---|
| Name: | FISHER OF MEN MINISTRIES |
| Entity type: | Organization |
| Organization Name: | FISHER OF MEN MINISTRIES |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | LAGEORGE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | WARE |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 307-248-6114 |
| Mailing Address - Street 1: | 30 N GOULD ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SHERIDAN |
| Mailing Address - State: | WY |
| Mailing Address - Zip Code: | 82801-6317 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 307-248-6114 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 30 N GOULD ST |
| Practice Address - Street 2: | |
| Practice Address - City: | SHERIDAN |
| Practice Address - State: | WY |
| Practice Address - Zip Code: | 82801-6317 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 307-248-6114 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2025-08-07 |
| Last Update Date: | 2025-08-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 251B00000X | Agencies | Case Management | |
| No | 251V00000X | Agencies | Voluntary or Charitable | |
| No | 253Z00000X | Agencies | In Home Supportive Care | |
| No | 261QC1500X | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
| No | 261QH0100X | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health |
| No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone |
| No | 261QP0905X | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local |
| No | 261QP2400X | Ambulatory Health Care Facilities | Clinic/Center | Prison Health |
| No | 261QR0400X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation |
| No | 261QR0401X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF) |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder |
