Provider Demographics
NPI:1538703715
Name:PERSONALIZED SUPPORT SERVICES
Entity Type:Organization
Organization Name:PERSONALIZED SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-797-1931
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:
Mailing Address - City:MILLS
Mailing Address - State:WY
Mailing Address - Zip Code:82644-1805
Mailing Address - Country:US
Mailing Address - Phone:307-797-1931
Mailing Address - Fax:
Practice Address - Street 1:1704 JIM BRIDGER AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3184
Practice Address - Country:US
Practice Address - Phone:307-797-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care