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
State | License ID | Taxonomies |
---|---|---|
MT | RN5466 | 163WC1500X, 163WH0200X, 251J00000X |
MT | LPN5577 | 164W00000X |
251E00000X, 372500000X, 372600000X, 373H00000X, 3747A0650X, 3747P1801X, 374U00000X, 376J00000X, 376K00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health | Group - Multi-Specialty |
Not Answered | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health | Group - Multi-Specialty |
Not Answered | 164W00000X | Nursing Service Providers | Licensed Practical Nurse | Group - Multi-Specialty | |
Not Answered | 251E00000X | Agencies | Home Health | ||
Not Answered | 251J00000X | Agencies | Nursing Care | ||
Not Answered | 372500000X | Nursing Service Related Providers | Chore Provider | Group - Multi-Specialty | |
Not Answered | 372600000X | Nursing Service Related Providers | Adult Companion | Group - Multi-Specialty | |
Not Answered | 373H00000X | Nursing Service Related Providers | Day Training/Habilitation Specialist | Group - Multi-Specialty | |
Not Answered | 3747A0650X | Nursing Service Related Providers | Technician | Attendant Care Provider | Group - Multi-Specialty |
Not Answered | 3747P1801X | Nursing Service Related Providers | Technician | Personal Care Attendant | Group - Multi-Specialty |
Not Answered | 374U00000X | Nursing Service Related Providers | Home Health Aide | Group - Multi-Specialty | |
Not Answered | 376J00000X | Nursing Service Related Providers | Homemaker | Group - Multi-Specialty | |
Not Answered | 376K00000X | Nursing Service Related Providers | Nurse's Aide | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MT | 0042497 | Medicaid | |
MT | 0380511 | Medicaid | |
MT | 0621758 | Medicaid |