Provider Demographics
NPI:1922077858
Name:SWEETWATER COUNTY COMMUNITY NURSING SERVICE
Entity Type:Organization
Organization Name:SWEETWATER COUNTY COMMUNITY NURSING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODYE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-352-6830
Mailing Address - Street 1:731 C ST
Mailing Address - Street 2:SUITE 315
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6202
Mailing Address - Country:US
Mailing Address - Phone:307-352-6830
Mailing Address - Fax:307-352-6844
Practice Address - Street 1:731 C ST
Practice Address - Street 2:SUITE 315
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6202
Practice Address - Country:US
Practice Address - Phone:307-352-6830
Practice Address - Fax:307-352-6844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY06-071251B00000X, 251E00000X, 251K00000X
WY07-008251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251E00000XAgenciesHome Health
Not Answered251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY537811Medicare ID - Type UnspecifiedPROVIDER ID