NPIMap

Organization Active NPI

Star Valley Healthcare, Inc.

  • Community Based Hospice Care Agency
  • Afton, WY
National Provider Identifier
1184101529
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
STAR VALLEY HEALTHCARE, INC.
Practice address
770 S Washington St Ste B
Afton, WY 83110-5135
Phone
(307) 885-7583
NPI assigned
Jul 27, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amber Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

770 S Washington St Ste B
Afton, WY 83110-5135

Mailing address

PO Box 607
Afton, WY 83110-0607
Phone (307) 885-7583

Other names 1

  • Symbii Hospice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181019002002 WY Part A Provider - Hospice 9931452000 Practice locations: Afton, WY

Hospice certification: CCN 531525

Legal name
STAR VALLEY HEALTHCARE, INC.
Doing business as
SYMBII HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 5, 2010
Last certification
Jan 6, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Jul 24, 2018 in NV
Enrollment address
770 S Washington St
Ste B
Afton, WY 83110

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Symbii HospiceCCN 531525
Ownership
For-Profit
Certified
Feb 5, 2010
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D2156224Symbii Hospice770 Washington St Ste B, Afton, WY 83110Certificate of waiverOct 11, 2026

National Provider Directory

National Provider Directory
Tax ID family
Star Valley Healthcare Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

770 S Washington St
#B
Afton, WY 83110
Phone (307) 885-7583

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID For-profit 5% Or Greater Direct Ownership Interest Sep 1, 2018 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate DirectorDirector Jul 1, 2022
Prescott Hansen Individual W-2 Managing EmployeeAdministrator Dec 21, 2022
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2019 100%
Andras T. Eder Individual W-2 Managing EmployeeMD; Jun 1, 2025
John J Gochnour Individual Corporate OfficerPresident Jul 11, 2024
Amber Tueller Individual Corporate OfficerSecretary Jul 11, 2024

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 141

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 141

Change-of-ownership history 1

DateEventCounterparty
Sep 1, 2018 Change of OwnershipThis provider was the buyer Signature Healthcare at HomeCCN 531525, WY, NPI 1952793820

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1532649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730160000000",
    "number": "1184101529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 607",
            "city": "AFTON",
            "state": "WY",
            "postal_code": "831100607",
            "telephone_number": "307-885-7583",
            "fax_number": "307-885-7584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 S WASHINGTON ST STE B",
            "city": "AFTON",
            "state": "WY",
            "postal_code": "831105135",
            "telephone_number": "307-885-7583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR VALLEY HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-27",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Symbii Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Afton, WY

Sources for this page

Verify at the official NPI Registry.