1235188996 NPI number — HOME OPTION INC

Table of content: BREANNA GRACE KEARNEY MSW (NPI 1366278350)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235188996 NPI number — HOME OPTION INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME OPTION 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:
1235188996
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1725 SHERIDAN AVE
Provider Second Line Business Mailing Address:
STE 128
Provider Business Mailing Address City Name:
CODY
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-587-4601
Provider Business Mailing Address Fax Number:
307-587-4608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 BIG HORN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORLAND
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-347-2481
Provider Business Practice Location Address Fax Number:
307-347-2471
Provider Enumeration Date:
05/09/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HERRICK
Authorized Official First Name:
CORALIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
INCORPORATOR
Authorized Official Telephone Number:
307-587-4601

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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