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General NPI Number Information
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NPI Number | 1114654761
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Entity Type | Organization
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Legal Business Name | FREMONT HOME HEALTH LLC
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Dates
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Enumeration Date | 08/03/2022
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 592 MAIN ST STE F
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City | LANDER
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State | WY
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Zip | 82520-3010
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Country | US
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Telephone | 307-438-2003
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 381
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City | CASPER
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State | WY
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Zip | 82602-0381
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MARC BERG
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Credential |
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Telephone | 360-518-3226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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