Casper Independent Living, LLC

Key facts

NPI

1578035440

Entity type

Organization (NPI type 2)

Primary specialty

Assisted Living Facility 310400000X

Legal business name

CASPER INDEPENDENT LIVING, LLC

Practice address

77 Gardenia St
Casper, WY 82604-3803

Phone

(307) 234-0572

Fax

(307) 237-0071

NPI assigned

Dec 17, 2018

Organization subpart

Yes

Parent organization (as reported)

EMPRES WYOMING HEALTHCARE, LLC

Authorized official

Name

Michael J. Miller

Title

Cfo and Assistant Manager

Phone

(360) 892-6628

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 17, 2018.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1545004800000",
    "number": "1578035440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 NE 77TH AVE STE 300",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986626736",
            "telephone_number": "360-892-6628",
            "fax_number": "360-882-5793"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 GARDENIA ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826043803",
            "telephone_number": "307-234-0572",
            "fax_number": "307-237-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CASPER INDEPENDENT LIVING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EMPRES WYOMING HEALTHCARE, LLC",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CFO AND ASSISTANT MANAGER",
        "authorized_official_telephone_number": "360-892-6628"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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