Healthcare Provider Details

I. General information

NPI: 1215660162
Provider Name (Legal Business Name): KINDRED SOULS OF WYOMING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S GILLETTE AVE STE 2
GILLETTE WY
82716-3722
US

IV. Provider business mailing address

320 S GILLETTE AVE STE 2
GILLETTE WY
82716-3722
US

V. Phone/Fax

Practice location:
  • Phone: 307-299-6792
  • Fax: 855-679-9725
Mailing address:
  • Phone: 307-299-6792
  • Fax: 855-679-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: RACHAEL ANN PETERSON
Title or Position: OWNER/RN
Credential: SKILLED NURSING
Phone: 307-299-6792