Active NPI
Platte County Hospital District Board
- Skilled Nursing Facility
- Wheatland, WY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 10302
- Legal business name
- PLATTE COUNTY HOSPITAL DISTRICT BOARD
- Practice address
- 100 19TH St
Wheatland, WY 82201-3162 - Phone
- (307) 322-7351
- Fax
- (307) 322-7351
- NPI assigned
- Oct 31, 2009
- Organization subpart
- Yes
- Parent organization
- PLATTE COUNTY HOSPITAL DISTRICT BOARD
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Josie Lauck, NHA
- Title
- Administrator
- Phone
- (307) 322-7351
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 10302 | WY | Primary |
Addresses
Primary practice location
100 19TH St
Wheatland, WY 82201-3162
Mailing address
204 15TH St
PO Box 1148
Wheatland, WY 82201
Phone (307) 322-6406
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 128523800 | Medicaid | WY |
Other names 1
- Platte County Legacy Home
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101027000747 | WY | Part A Provider - Skilled Nursing Facility | 1951595628 | Practice locations: Wheatland, WY |
Skilled nursing facility certification: CCN 535053
- Legal name
- PLATTE COUNTY HOSPITAL DISTRICT BOARD
- Doing business as
- PLATTE COUNTY LEGACY HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 2010
- Last certification
- Jul 25, 2024
- Beds
- 50
- Ownership / control type
- Other Nonprofit
- Organization structure
- Other
- Enrollment address
- 100 19TH St
Wheatland, WY 82201-3162 - Nursing home name
- PLATTE COUNTY LEGACY HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Platte County Legacy Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Other
- Certified
- Nov 1, 2010
- Medicare certification status
- Active
- Certified beds
- 50
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 53D1106553 | Platte County Legacy Home | Certificate of waiver | Oct 15, 2027 |
National Provider Directory
National Provider Directory- Part of
- Platte County Hospital District Board
Locations
100 19th St
Wheatland, WY 82201
Phone (307) 322-6406
Ownership & related parties
All disclosed owners & managing parties 5
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Lauri a Palmer | Operational/Managerial Control | Dec 9, 2024 | |
| Adp of the SNF | Dec 9, 2024 | ||
| Charles Frederick | Corporate Director | Feb 4, 2013 | |
| Jalea Jo Brockman | Operational/Managerial Control | Dec 9, 2024 | |
| Adp of the SNF | Dec 9, 2024 | ||
| Platte County Hospital District Board | 5% Or Greater Direct Ownership Interest | Nov 1, 2009 | 100% |
| Operational/Managerial Control | Jan 1, 2023 | ||
| Adp of the SNF | Nov 1, 2009 | ||
| Lori Modesitt | Corporate Director | Aug 24, 2010 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Wheatland, WY
- NPI 1154411957
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Wheatland, WY
- NPI 1154411957
Affiliated clinicians 1
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": "1256947200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1714435200000",
"number": "1821324567",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "204 15TH ST",
"address_2": "PO BOX 1148",
"city": "WHEATLAND",
"state": "WY",
"postal_code": "82201",
"telephone_number": "307-322-6406",
"fax_number": "307-322-4065"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 19TH ST",
"city": "WHEATLAND",
"state": "WY",
"postal_code": "822013162",
"telephone_number": "307-322-7351",
"fax_number": "307-322-7351"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PLATTE COUNTY HOSPITAL DISTRICT BOARD",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "PLATTE COUNTY HOSPITAL DISTRICT BOARD",
"enumeration_date": "2009-10-31",
"last_updated": "2024-04-30",
"certification_date": "2024-04-30",
"status": "A",
"authorized_official_last_name": "LAUCK",
"authorized_official_first_name": "JOSIE",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "307-322-7351",
"authorized_official_credential": "NHA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "WY",
"license": "10302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "128523800",
"state": "WY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Platte County Legacy Home",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Wheatland, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.