Provider Demographics
NPI:1821324567
Name:PLATTE COUNTY HOSPITAL DISTRICT BOARD
Entity type:Organization
Organization Name:PLATTE COUNTY HOSPITAL DISTRICT BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:307-322-7351
Mailing Address - Street 1:204 15TH ST
Mailing Address - Street 2:PO BOX 1148
Mailing Address - City:WHEATLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82201
Mailing Address - Country:US
Mailing Address - Phone:307-322-6406
Mailing Address - Fax:307-322-4065
Practice Address - Street 1:100 19TH ST
Practice Address - Street 2:
Practice Address - City:WHEATLAND
Practice Address - State:WY
Practice Address - Zip Code:82201-3162
Practice Address - Country:US
Practice Address - Phone:307-322-7351
Practice Address - Fax:307-322-7351
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLATTE COUNTY HOSPITAL DISTRICT BOARD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-31
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10302314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY128523800Medicaid
WY53A043Medicaid