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General NPI Number Information
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NPI Number | 1265793624
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Entity Type | Organization
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Legal Business Name | SENIOR CITIZENS COUNCIL
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Dates
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Enumeration Date | 06/01/2012
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Last Update Date | 06/01/2012
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Provider Practice Location Address
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Address Line | 211 SMITH ST
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City | SHERIDAN
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State | WY
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Zip | 82801-3818
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Country | US
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Telephone | 307-672-2240
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Fax | 307-674-9866
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Provider Business Mailing Address
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Address Line | 211 SMITH ST
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City | SHERIDAN
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State | WY
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Zip | 82801-3818
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Country | US
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Telephone | 307-672-2240
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Fax | 307-674-9866
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. CARMEN RIDEOUT
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Credential |
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Telephone | 307-672-2240
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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 | 10218
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License Number State | WY
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