Provider Demographics
NPI:1073535712
Name:SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Other - Org Name:BONNIE BLUEJACKET MEMORIAL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHROEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-568-3311
Mailing Address - Street 1:388 SOUTH US HWY 20
Mailing Address - Street 2:
Mailing Address - City:BASIN
Mailing Address - State:WY
Mailing Address - Zip Code:82410-8902
Mailing Address - Country:US
Mailing Address - Phone:307-568-3311
Mailing Address - Fax:307-568-2139
Practice Address - Street 1:388 SOUTH US HWY 20
Practice Address - Street 2:
Practice Address - City:BASIN
Practice Address - State:WY
Practice Address - Zip Code:82410-8902
Practice Address - Country:US
Practice Address - Phone:307-568-3311
Practice Address - Fax:307-568-2139
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
313M00000X
WY07-0013140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106024402Medicaid
WY007385OtherBLUE SHIELD
WY106024401Medicaid
WY106024401Medicaid
WY106024402Medicaid
WY535019WMedicare PIN