Provider Demographics
NPI:1871895441
Name:MEMORIAL HOSPITAL OF CARBON COUNTY COMMUNITY BASED IN HOME SERVICES
Entity type:Organization
Organization Name:MEMORIAL HOSPITAL OF CARBON COUNTY COMMUNITY BASED IN HOME SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-324-8252
Mailing Address - Street 1:2221 ELM ST
Mailing Address - Street 2:PO BOX 460
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5108
Mailing Address - Country:US
Mailing Address - Phone:307-324-8252
Mailing Address - Fax:307-324-8236
Practice Address - Street 1:2221 ELM ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5108
Practice Address - Country:US
Practice Address - Phone:307-324-8252
Practice Address - Fax:307-324-8236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251B00000X251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management