Provider Demographics
NPI:1700871670
Name:SUBLETTE CENTER
Entity Type:Organization
Organization Name:SUBLETTE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-367-4161
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:WY
Mailing Address - Zip Code:82941-0788
Mailing Address - Country:US
Mailing Address - Phone:307-367-4161
Mailing Address - Fax:307-367-4135
Practice Address - Street 1:333 N BRIDGER AVE
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941-0788
Practice Address - Country:US
Practice Address - Phone:307-367-4161
Practice Address - Fax:307-367-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY06-125314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY535017Medicare Oscar/Certification