Healthcare Provider Details

I. General information

NPI: 1811994122
Provider Name (Legal Business Name): BCBU, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 RIVER VIEW DR STE A
GREEN RIVER WY
82935-4811
US

IV. Provider business mailing address

576 W. 900 S. SUITE 260
WOODS CROSS UT
84010-8127
US

V. Phone/Fax

Practice location:
  • Phone: 307-875-7976
  • Fax: 307-875-8990
Mailing address:
  • Phone: 801-397-4600
  • Fax: 801-397-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number05164
License Number StateWY

VIII. Authorized Official

Name: MR. DEE R BANGERTER
Title or Position: CEO
Credential:
Phone: 801-397-4000