1376688580 NPI number — ST. JOSEPH'S CHILDREN'S HOME

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 1376688580 NPI number — ST. JOSEPH'S CHILDREN'S HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. JOSEPH'S CHILDREN'S HOME
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:
1376688580
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1419 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRINGTON
Provider Business Mailing Address State Name:
WY
Provider Business Mailing Address Postal Code:
82240-3340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
307-532-4197
Provider Business Mailing Address Fax Number:
307-532-8405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1419 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRINGTON
Provider Business Practice Location Address State Name:
WY
Provider Business Practice Location Address Postal Code:
82240-3340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
307-532-4197
Provider Business Practice Location Address Fax Number:
307-532-8405
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEYER
Authorized Official First Name:
RONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
307-532-4197

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  5405 I , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 323P00000X , with the licence number: 5405I , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111833101 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200051290 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111833103 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111833104 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111833105 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".




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