Provider Demographics
NPI:1740744473
Name:STILLWATER HOSPICE OF NORTHERN WYOMING LLC
Entity type:Organization
Organization Name:STILLWATER HOSPICE OF NORTHERN WYOMING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-671-5686
Mailing Address - Street 1:444 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELL
Mailing Address - State:WY
Mailing Address - Zip Code:82431-1958
Mailing Address - Country:US
Mailing Address - Phone:406-671-5686
Mailing Address - Fax:
Practice Address - Street 1:444 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:LOVELL
Practice Address - State:WY
Practice Address - Zip Code:82431-1958
Practice Address - Country:US
Practice Address - Phone:406-671-5686
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based