CANDICE RAE GRONBERG (NPI# 1356632087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1356632087 |
Entity Type | Individual |
Full Name | CANDICE RAE GRONBERG |
Practice Address |
4 Roberts Road Lander WY 82520-1401 |
Mailing Address |
Po Box 1401 4 Roberts Road Lander WY 82520-1401 |
Practice Telephone | 3073329122 |
Practice Fax Number | 3073329122 |
Mailing Telephone | 3073329122 |
Mailing Fax Number | 3073329122 |
Enumeration Date | 2011-04-28 |
Last Update Date | 2011-04-28 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 385HR2060X |
Respite Care Specialization: Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
114858300 | WY | Respite Care Facility |
Street Address |
4 ROBERTS ROAD |
City | LANDER |
State | WY |
Zip Code | 82520-1401 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1689288201 | Wind River Wraparound | Community/Behavioral Health | 16 Sandhills Rd., Lander, WY 82520 | 2020-09-01 |
1346700622 | Wind River Family & Community Health Care | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 510 Ethete Rd., Ethete, WY 82520 | 2019-03-22 |
1447710843 | Wind River Family and Community Health Care | Clinic/Center | 510 Ethete Road, Ethete, WY 82520 | 2019-03-21 |
1780103614 | John Thomas Scarince | Case Manager/Care Coordinator | 748 Main, Lander, WY 82520 | 2017-09-12 |
1326560780 | Benessere Clinic LLC | Specialist | 195 Capitol St., Lander, WY 82520 | 2017-07-07 |
1881134500 | Susan Kreager | Nutritionist | 643 Blue Sky Hwy 132, Ethete, WY 82520 | 2017-02-28 |
1346792298 | Elisabeth Krause | Clinic/Center | 65 N, Granier Ave, Atlantic City, WY 82520 | 2016-10-26 |
1649640368 | Melinda Kay Cox | Day Training, Developmentally Disabled Services | 382 Washakie, Lander, WY 82520 | 2015-10-07 |
1942602677 | Carmen Champlin | Registered Nurse | 397 S 5th, Lander, WY 82520 | 2014-09-25 |
1366867806 | Kelly Johnson | Social Worker | 7324 Highway 789, Lander, WY 82520 | 2014-02-20 |
Find all providers in zip 82520 |
Taxonomy Code | 385HR2060X |
Grouping | Respite Care Facility |
Classification | Respite Care |
Specialization | Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental retardation and/or developmental disabilities as respite for the regular caregivers. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1942830823 | Toni Rae Vavra-wilder | Respite Care | 2407 E 16th St, Cheyenne, WY 82001-5307 | 2020-01-20 |
1013454438 | Shelby Elliott | Respite Care | 1634 Jim Bridger Ave, Casper, WY 82604-3121 | 2017-01-23 |
1225406754 | Patricia Masters | Respite Care | 6678 Bailey Place, Casper, WY 82604 | 2015-09-15 |
1669601217 | Jy Adekale Global Initiative | Respite Care | 4913 Ridge Rd, Cheyenne, WY 82009-5309 | 2009-07-03 |
1316181167 | Danielle Marie Naughton | Respite Care | 1931 S Washington St, Casper, WY 82601-4855 | 2009-04-23 |
1184893026 | Hope Unlimited,inc | Respite Care | 133 Shady Ln, Evanston, WY 82930-4761 | 2008-02-25 |
1689866790 | Mark Alan Courtney | Respite Care | 2508 Central Ave, Cody, WY 82414-9797 | 2007-08-13 |
1730380106 | Heather Louise Haskell | Respite Care | 261 Shipwheel Rd, Moorcroft, WY 82721 | 2007-05-31 |
1538370895 | Cheyenne Assisted Living & Support | Respite Care | 807 Mitchell Ct, Cheyenne, WY 82007-2814 | 2007-05-25 |
1750429262 | Kathleen L. Otte | Respite Care | 382 N Lincoln St, Laramie, WY 82070-6100 | 2007-02-05 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.