Healthcare Provider Details

I. General information

NPI: 1851481634
Provider Name (Legal Business Name): MORNING STAR CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/22/2020
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 NORTH FORK RD
FORT WASHAKIE WY
82514-0859
US

IV. Provider business mailing address

PO BOX 859 4 NORTH FORK RD
FORT WASHAKIE WY
82514-0859
US

V. Phone/Fax

Practice location:
  • Phone: 307-332-6902
  • Fax: 307-332-4279
Mailing address:
  • Phone: 307-332-6902
  • Fax: 307-332-4279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number07-153
License Number StateWY

VIII. Authorized Official

Name: TAMARA A REED
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 307-332-6902