Provider Demographics
NPI:1326019670
Name:INTERIM HEALTHCARE OF WYOMING INC
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF WYOMING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSSHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-621-0902
Mailing Address - Street 1:1010 E. 1ST STREET SUITE A
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601
Mailing Address - Country:US
Mailing Address - Phone:307-266-1152
Mailing Address - Fax:307-577-8041
Practice Address - Street 1:1010 E. 1ST STREET SUITE A
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601
Practice Address - Country:US
Practice Address - Phone:307-266-1152
Practice Address - Fax:307-577-8041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
WY0713055251B00000X, 251E00000X
WY06-051251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY107148316Medicaid
WY107148300Medicaid
WY537042Medicare Oscar/Certification