Provider Demographics
NPI:1760645600
Name:SUBLETTE CENTER
Entity Type:Organization
Organization Name:SUBLETTE CENTER
Other - Org Name:SUBLETTE CENTER HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:M DIV LNHA
Authorized Official - Phone:307-367-4161
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941
Mailing Address - Country:US
Mailing Address - Phone:307-367-4161
Mailing Address - Fax:307-367-3160
Practice Address - Street 1:333 N. BRIDGER AVE
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:307-367-4161
Practice Address - Fax:307-367-3160
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUBLETTE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN PROCESS251G00000X
WY10308251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
531524Medicare Oscar/Certification