Provider Demographics
NPI:1265501613
Name:UINTA SENIOR CITIZENS
Entity Type:Organization
Organization Name:UINTA SENIOR CITIZENS
Other - Org Name:UINTA HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-7712
Mailing Address - Street 1:1229 UINTA ST
Mailing Address - Street 2:P.O. 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:
Practice Address - Street 1:1229 UINTA ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3236
Practice Address - Country:US
Practice Address - Phone:307-789-7712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07-112251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY109190501Medicaid
WY531514Medicare Oscar/Certification