MEDICARE: HIGH COUNTRY HEALTH, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	5003556	WY

General Provider Information

NPI Number	:	1114131794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH COUNTRY HEALTH, INC

Provider Business Mailing Address
First Line	:	3131 E GRAND AVE UNIT A
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5140
Country	:	US
Telephone Number	:	307-742-3120
Fax Number	:	307-742-4557

Provider Business Practice Location Address
First Line	:	3131 E GRAND AVE UNIT A
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82070-5140
Country	:	US
Telephone Number	:	307-742-3120
Fax Number	:	307-742-4557

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARILYN PEDRICK
Credential	:
Telephone Number	:	307-742-3120

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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