1184611089 NPI number — NOYES HEALTH CARE CENTER INC

Table of content: (NPI 1184611089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184611089 NPI number — NOYES HEALTH CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOYES HEALTH CARE CENTER INC
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:
1184611089
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POB 307
Provider Second Line Business Mailing Address:
305 WHIPPOORWILL ST
Provider Business Mailing Address City Name:
BAGGS
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82321-0307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-383-7000
Provider Business Mailing Address Fax Number:
307-383-7005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 WHIPPOORWILL ST
Provider Second Line Business Practice Location Address:
POB 307
Provider Business Practice Location Address City Name:
BAGGS
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82321-0307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-383-7000
Provider Business Practice Location Address Fax Number:
307-383-7005
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BRYANT
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
307-383-7000

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 37254014 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 304215 . This is a "BLUE CROSS" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 106495900 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com