Provider Demographics
NPI:1730290230
Name:ROCK SPRINGS YOUNG AT HEART
Entity Type:Organization
Organization Name:ROCK SPRINGS YOUNG AT HEART
Other - Org Name:YAH HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-352-6737
Mailing Address - Street 1:2400 REAGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-4531
Mailing Address - Country:US
Mailing Address - Phone:307-352-1283
Mailing Address - Fax:307-352-1285
Practice Address - Street 1:2400 REAGAN AVE
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4531
Practice Address - Country:US
Practice Address - Phone:307-352-1283
Practice Address - Fax:307-352-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1092561000251B00000X
WYPENDING251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1092561000Medicaid
WY08-201OtherSTATE LICENSE NUMBER
WY08-201OtherSTATE LICENSE NUMBER