Provider Demographics
NPI:1265479075
Name:UINTA SENIOR CITIZENS
Entity Type:Organization
Organization Name:UINTA SENIOR CITIZENS
Other - Org Name:UINTA HOME HEALTH AND HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:OTTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-7712
Mailing Address - Street 1:1229 UINTA ST
Mailing Address - Street 2:PO BOX 728
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-3236
Mailing Address - Country:US
Mailing Address - Phone:307-789-7712
Mailing Address - Fax:307-789-7191
Practice Address - Street 1:1229 UINTA ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82931-0728
Practice Address - Country:US
Practice Address - Phone:307-789-7712
Practice Address - Fax:307-789-7191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY06-058251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY537055Medicare Oscar/Certification
WY531514Medicare Oscar/Certification