Provider Demographics
NPI:1114086402
Name:CROOK COUNTY MEDICAL SERVICES DISTRICT
Entity Type:Organization
Organization Name:CROOK COUNTY MEDICAL SERVICES DISTRICT
Other - Org Name:CROOK COUNTY NURSING FACILITY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:DAHNE
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:307-283-3501
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:713 OAK STREET
Mailing Address - City:SUNDANCE
Mailing Address - State:WY
Mailing Address - Zip Code:82729-0517
Mailing Address - Country:US
Mailing Address - Phone:307-283-3501
Mailing Address - Fax:307-283-2255
Practice Address - Street 1:713 OAK STREET
Practice Address - Street 2:
Practice Address - City:SUNDANCE
Practice Address - State:WY
Practice Address - Zip Code:82729-0517
Practice Address - Country:US
Practice Address - Phone:307-283-3501
Practice Address - Fax:307-283-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 314000000X, 315D00000X, 385H00000X
WY07-105282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No282E00000XHospitalsLong Term Care Hospital
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106168201Medicaid
WY106168205Medicaid
WY106168210Medicaid