Provider Demographics
NPI:1275830325
Name:PREMIUM HEALTH AT HOME RAWLINS LLC
Entity Type:Organization
Organization Name:PREMIUM HEALTH AT HOME RAWLINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-742-8710
Mailing Address - Street 1:405 W CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5636
Mailing Address - Country:US
Mailing Address - Phone:307-328-5999
Mailing Address - Fax:307-324-9358
Practice Address - Street 1:405 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5636
Practice Address - Country:US
Practice Address - Phone:307-328-5999
Practice Address - Fax:307-324-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251B00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management