Provider Demographics
NPI:1376620989
Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:CAMPBELL COUNTY HOSPITAL DISTRICT
Other - Org Name:THE LEGACY LIVING & REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONNI
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:BELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-688-7112
Mailing Address - Street 1:1000 S DOUGLAS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716
Mailing Address - Country:US
Mailing Address - Phone:307-688-7000
Mailing Address - Fax:307-688-7101
Practice Address - Street 1:1000 S DOUGLAS HIGHWAY
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716
Practice Address - Country:US
Practice Address - Phone:307-688-7000
Practice Address - Fax:307-688-7101
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAMPBELL COUNTY HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-01
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07065313M00000X
WY15143313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119417800Medicaid
WY535022Medicare PIN
WY535022Medicare Oscar/Certification