Provider Demographics
NPI:1407000342
Name:SUMMIT HOME HEALTH CARE
Entity Type:Organization
Organization Name:SUMMIT HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-760-4338
Mailing Address - Street 1:204 MCCOLLUM DR STE 106
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5151
Mailing Address - Country:US
Mailing Address - Phone:307-721-2827
Mailing Address - Fax:307-742-3611
Practice Address - Street 1:204 MCCOLLUM DR STE 106
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5151
Practice Address - Country:US
Practice Address - Phone:307-721-2827
Practice Address - Fax:307-742-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
WY251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119002400Medicaid