Provider Demographics
NPI:1851860886
Name:BEYOND HOME ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:BEYOND HOME ASSISTED LIVING LLC
Other - Org Name:BEYOND HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CACHE
Authorized Official - Middle Name:D
Authorized Official - Last Name:KENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:307-248-1530
Mailing Address - Street 1:87926 US HWY 89
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:WY
Mailing Address - Zip Code:83110
Mailing Address - Country:US
Mailing Address - Phone:307-248-1530
Mailing Address - Fax:
Practice Address - Street 1:153 DOYLE CHILD CIRCLE
Practice Address - Street 2:
Practice Address - City:AFTON
Practice Address - State:WY
Practice Address - Zip Code:83110
Practice Address - Country:US
Practice Address - Phone:307-248-1530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility