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General NPI Number Information
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NPI Number | 1023922259
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Entity Type | Organization
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Legal Business Name | TIR NAN GRAS, LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 906 GRACE AVE
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City | WORLAND
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State | WY
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Zip | 82401-3424
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Country | US
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Telephone | 307-349-0880
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Fax |
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Provider Business Mailing Address
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Address Line | 322 TWEED LN
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City | LANDER
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State | WY
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Zip | 82520-9740
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Country | US
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Telephone | 307-349-0880
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NICOLE BEDDOES
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Credential |
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Telephone | 307-349-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | NULL
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