Provider Demographics
NPI:1922167915
Name:INTERIM HEALTHCARE OF WYOMING, INC.
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE OF WYOMING, INC.
Other - Org Name:PROFESSIONAL NURSING PERSONNEL POOL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-252-8794
Mailing Address - Street 1:3316 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2005
Mailing Address - Country:US
Mailing Address - Phone:406-252-8794
Mailing Address - Fax:406-248-6575
Practice Address - Street 1:3316 2ND AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2005
Practice Address - Country:US
Practice Address - Phone:406-252-8794
Practice Address - Fax:406-248-6575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN5466163WC1500X, 163WH0200X, 251J00000X
MTLPN5577164W00000X
251E00000X, 372500000X, 372600000X, 373H00000X, 3747A0650X, 3747P1801X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Multi-Specialty
Not Answered163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
Not Answered164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
Not Answered251E00000XAgenciesHome Health
Not Answered251J00000XAgenciesNursing Care
Not Answered372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
Not Answered372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
Not Answered373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
Not Answered3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Not Answered374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Not Answered376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Not Answered376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0042497Medicaid
MT0380511Medicaid
MT0621758Medicaid