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General NPI Number Information
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NPI Number | 1457890659
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Entity Type | Organization
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Legal Business Name | BEYOND HOME LIVING, LLC
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Dates
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Enumeration Date | 02/21/2017
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 153 DOYLE CHILD CIRCLE
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City | AFTON
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State | WY
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Zip | 83110
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Country | US
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Telephone | 307-887-0006
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Fax |
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Provider Business Mailing Address
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Address Line | 635 BIG RIDGE MEADOWS DR
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City | AFTON
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State | WY
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Zip | 83110-8713
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Country | US
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Telephone | 307-887-0006
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | JEFFREY ROSENBERG
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Credential |
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Telephone | 307-887-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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