1093984510 NPI number — ALLIANCE HOSPICE OF STAR VALLEY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093984510 NPI number — ALLIANCE HOSPICE OF STAR VALLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLIANCE HOSPICE OF STAR VALLEY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093984510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 BRIDGER DR
Provider Second Line Business Mailing Address:
PO BOX 1001
Provider Business Mailing Address City Name:
THAYNE
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
83127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-883-7583
Provider Business Mailing Address Fax Number:
307-883-7584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 BRIDGER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THAYNE
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
83127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-883-7583
Provider Business Practice Location Address Fax Number:
307-883-7584
Provider Enumeration Date:
02/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALTHER
Authorized Official First Name:
KARRIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF NURSING
Authorized Official Telephone Number:
307-883-7583

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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