| NPI | 1841254844 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIN PETERSEN Provider Enrollment Specialist 307-432-3664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251G00000X Hospice Care, Community Based (Licence: WY 251G00000X) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2024-03-22 |