Provider Demographics
NPI:1821324567
Name:PLATTE COUNTY HOSPITAL DISTRICT BOARD
Entity Type:Organization
Organization Name:PLATTE COUNTY HOSPITAL DISTRICT BOARD
Other - Org Name:PLATTE COUNTY MEMORIAL NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-532-0301
Mailing Address - Street 1:204 15TH ST
Mailing Address - Street 2:PO BOX 1148
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201
Mailing Address - Country:US
Mailing Address - Phone:307-322-6406
Mailing Address - Fax:307-322-4065
Practice Address - Street 1:204 15TH ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201
Practice Address - Country:US
Practice Address - Phone:307-322-6406
Practice Address - Fax:307-322-4065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLATTE COUNTY HOSPITAL DISTRICT BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-31
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY53A043Medicaid
WY53A043Medicaid