Provider Demographics
NPI:1376996959
Name:SUMMIT HOME HEALTH CARE
Entity Type:Organization
Organization Name:SUMMIT HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-760-4338
Mailing Address - Street 1:2510 E 15TH ST
Mailing Address - Street 2:ST 5
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82609-4111
Mailing Address - Country:US
Mailing Address - Phone:307-333-4379
Mailing Address - Fax:307-333-4981
Practice Address - Street 1:2510 E 15TH ST
Practice Address - Street 2:ST 5
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-4111
Practice Address - Country:US
Practice Address - Phone:307-333-4379
Practice Address - Fax:307-333-4981
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT HOME HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-19
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYP-912251B00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY144113200Medicaid
WY537077Medicare PIN