Provider Demographics
NPI:1922146323
Name:HEART MOUNTAIN HEALTHCARE LLC
Entity Type:Organization
Organization Name:HEART MOUNTAIN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AYDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-587-3838
Mailing Address - Street 1:615 15TH ST # 3
Mailing Address - Street 2:PO BOX 1716
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3109
Mailing Address - Country:US
Mailing Address - Phone:307-587-3838
Mailing Address - Fax:307-587-2455
Practice Address - Street 1:615 15TH ST # 3
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3109
Practice Address - Country:US
Practice Address - Phone:307-587-3838
Practice Address - Fax:307-587-2455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY13276163W00000X
WY261225100000X
251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services