Provider Demographics
NPI:1972834042
Name:EMG CHEYENNE SH LLC
Entity Type:Organization
Organization Name:EMG CHEYENNE SH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:GISI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-741-6230
Mailing Address - Street 1:2850 24TH AVE S
Mailing Address - Street 2:STE 201
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5831
Mailing Address - Country:US
Mailing Address - Phone:701-738-2000
Mailing Address - Fax:701-757-4701
Practice Address - Street 1:4606 N COLLEGE DR
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-5456
Practice Address - Country:US
Practice Address - Phone:701-738-2000
Practice Address - Fax:701-757-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility