Healthcare Provider Details

I. General information

NPI: 1518001064
Provider Name (Legal Business Name): SPRING WIND ASSIST LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 N 22ND ST
LARAMIE WY
82072-5303
US

IV. Provider business mailing address

PO BOX 3006
SALEM OR
97302-0006
US

V. Phone/Fax

Practice location:
  • Phone: 307-755-5811
  • Fax: 503-485-1495
Mailing address:
  • Phone: 503-485-4600
  • Fax: 503-485-1495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number07-052
License Number StateWY

VIII. Authorized Official

Name: JON HARDER
Title or Position: CEO PRESIDENT
Credential:
Phone: 503-485-4600