Healthcare Provider Details

I. General information

NPI: 1376787812
Provider Name (Legal Business Name): BIOHEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E. BROADWAY STE 210
JACKSON WY
83001
US

IV. Provider business mailing address

PO BOX 4548
JACKSON WY
83001
US

V. Phone/Fax

Practice location:
  • Phone: 307-739-7532
  • Fax: 307-739-7613
Mailing address:
  • Phone: 307-739-7532
  • Fax: 307-739-7613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberWY040239
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. JOY NELSON LUNDEEN
Title or Position: PRINCIPLE/OWNER
Credential: RN
Phone: 307-739-7532