Provider Demographics
NPI:1215660162
Name:KINDRED SOULS OF WYOMING LLC
Entity type:Organization
Organization Name:KINDRED SOULS OF WYOMING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/RN
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:SKILLED NURSING
Authorized Official - Phone:307-299-6792
Mailing Address - Street 1:320 S GILLETTE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716-3722
Mailing Address - Country:US
Mailing Address - Phone:307-299-6792
Mailing Address - Fax:855-679-9725
Practice Address - Street 1:320 S GILLETTE AVE STE A
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-3722
Practice Address - Country:US
Practice Address - Phone:307-299-6792
Practice Address - Fax:855-679-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care
No364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome HealthGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY18971OtherBOARD CERTIFIED NURSE COACH
WY41550OtherREGISTERED NURSE