Provider Demographics
NPI:1699472001
Name:TENNYSONS HOME CARE
Entity type:Organization
Organization Name:TENNYSONS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA/CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KAREEN
Authorized Official - Last Name:LAKE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:307-321-4085
Mailing Address - Street 1:4012 RAIN DANCER TRL
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-8593
Mailing Address - Country:US
Mailing Address - Phone:307-321-4085
Mailing Address - Fax:
Practice Address - Street 1:4012 RAIN DANCER TRL
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-8593
Practice Address - Country:US
Practice Address - Phone:307-321-4085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TENNYSONS HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health