Provider Demographics
NPI:1457358376
Name:TENDER HEART HOME CARE HOSPICE
Entity type:Organization
Organization Name:TENDER HEART HOME CARE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BBA,
Authorized Official - Phone:307-789-8969
Mailing Address - Street 1:PO BOX 2130
Mailing Address - Street 2:624 TWIN RIDGE
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-2130
Mailing Address - Country:US
Mailing Address - Phone:307-789-8969
Mailing Address - Fax:307-789-8907
Practice Address - Street 1:624 TWIN RIDGE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82931-2130
Practice Address - Country:US
Practice Address - Phone:307-789-8969
Practice Address - Fax:307-789-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY537043AMedicare Oscar/Certification