Provider Demographics
NPI:1558319392
Name:WILLIAM H AND CARRIE GOTTSCHE FOUNDATION
Entity Type:Organization
Organization Name:WILLIAM H AND CARRIE GOTTSCHE FOUNDATION
Other - Org Name:GOTTSCHE REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-864-2146
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:THERMOPOLIS
Mailing Address - State:WY
Mailing Address - Zip Code:82443-0790
Mailing Address - Country:US
Mailing Address - Phone:307-864-2146
Mailing Address - Fax:307-864-2857
Practice Address - Street 1:148 E ARAPAHOE ST
Practice Address - Street 2:
Practice Address - City:THERMOPOLIS
Practice Address - State:WY
Practice Address - Zip Code:82443-2402
Practice Address - Country:US
Practice Address - Phone:307-864-2146
Practice Address - Fax:307-864-2857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X, 261QX0100X
WY06-045261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY106030900Medicaid
WYDB3572OtherPALMETTO GBA (RAILROAD MEDICARE)
WY239850900OtherUS DEPARTMENT OF LABOR
WY239850900OtherUS DEPARTMENT OF LABOR
WY0195450001Medicare NSC
WYDB3572OtherPALMETTO GBA (RAILROAD MEDICARE)