Provider Demographics
NPI:1184777625
Name:SUMMIT HOME HEALTH CARE
Entity type:Organization
Organization Name:SUMMIT HOME HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-721-2827
Mailing Address - Street 1:204 MCCOLLUM DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-5103
Mailing Address - Country:US
Mailing Address - Phone:307-721-2827
Mailing Address - Fax:307-742-3611
Practice Address - Street 1:204 MCCOLLUM DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-5103
Practice Address - Country:US
Practice Address - Phone:307-721-2827
Practice Address - Fax:307-742-3611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10236251B00000X
WY07 096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY119002400Medicaid
WY119002401Medicaid
WY119002402Medicaid
WY119002401Medicaid
WY119002402Medicaid