Provider Demographics
NPI:1073842225
Name:MEMORIAL HOSPITAL OF LARAMIE COUNTY
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL OF LARAMIE COUNTY
Other - Org Name:CHEYENNE REGIONAL MEDICAL CENTER-HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERARTIONS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MALATESTA
Authorized Official - Suffix:
Authorized Official - Credentials:HCSD
Authorized Official - Phone:307-633-7001
Mailing Address - Street 1:214 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3748
Mailing Address - Country:US
Mailing Address - Phone:307-633-7000
Mailing Address - Fax:307-633-7075
Practice Address - Street 1:2600 E 18TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5511
Practice Address - Country:US
Practice Address - Phone:307-633-7000
Practice Address - Fax:307-633-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10186251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1598993776Medicaid
WY1134357312Medicaid
WY1316175599Medicaid
WY1780812966Medicaid