Provider Demographics
NPI:1497812077
Name:WESTON COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:WESTON COUNTY HOSPITAL DISTRICT
Other - Org Name:WESTON COUNTY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CADWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-746-4491
Mailing Address - Street 1:1124 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-2972
Mailing Address - Country:US
Mailing Address - Phone:307-746-4491
Mailing Address - Fax:307-746-4579
Practice Address - Street 1:1124 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2972
Practice Address - Country:US
Practice Address - Phone:307-746-4491
Practice Address - Fax:307-746-4579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY07137314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY114292505Medicaid
WY114292505Medicaid