Provider Demographics
NPI:1215025788
Name:SHARONS HOSPICE AND PALLIATIVE CARE INC
Entity Type:Organization
Organization Name:SHARONS HOSPICE AND PALLIATIVE CARE INC
Other - Org Name:TREASURED MEMORIES HOSPICE & PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KANODE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-756-3344
Mailing Address - Street 1:PO BOX 73
Mailing Address - Street 2:
Mailing Address - City:MOORCROFT
Mailing Address - State:WY
Mailing Address - Zip Code:82721-0073
Mailing Address - Country:US
Mailing Address - Phone:307-756-3344
Mailing Address - Fax:307-756-3394
Practice Address - Street 1:116 N. LITTLE HORN
Practice Address - Street 2:
Practice Address - City:MOORCROFT
Practice Address - State:WY
Practice Address - Zip Code:82721
Practice Address - Country:US
Practice Address - Phone:307-756-3344
Practice Address - Fax:307-756-3394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07188251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114074403Medicaid
WY114074403Medicaid