Healthcare Provider Details

I. General information

NPI: 1407835960
Provider Name (Legal Business Name): HOSPICE OF LARAMIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1754 CENTENNIAL DR
LARAMIE WY
82070-8417
US

IV. Provider business mailing address

1754 CENTENNIAL DR
LARAMIE WY
82070-8417
US

V. Phone/Fax

Practice location:
  • Phone: 307-745-9254
  • Fax: 307-742-5967
Mailing address:
  • Phone: 307-745-9254
  • Fax: 307-742-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0713111
License Number StateWY

VIII. Authorized Official

Name: TERRI LONGHURST
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 307-745-9254