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General NPI Number Information
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NPI Number | 1780745885
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Entity Type | Organization
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Legal Business Name | POWELL VALLEY HEALTH CARE INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-1101
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Fax | 307-754-3176
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Provider Business Mailing Address
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Address Line | 777 AVENUE H
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City | POWELL
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State | WY
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Zip | 82435-2260
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Country | US
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Telephone | 307-754-1101
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Fax | 307-754-3176
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Authorized Official
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Title or Position | CEO
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Name | TERRY ODOM
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Credential |
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Telephone | 307-754-1101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 07084
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License Number State | WY
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