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Organization Active NPI

Hospice of Sweetwater County

  • Community Based Hospice Care Agency
  • Rock Springs, WY
National Provider Identifier
1992767263
Registry record updated Nov 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
06-088 Issued in WY
Legal business name
HOSPICE OF SWEETWATER COUNTY
Practice address
333 Broadway
Suite 220
Rock Springs, WY 82901-7272
Phone
(307) 362-1990
NPI assigned
Apr 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2019

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

Authorized official

Name
Nicole M Mandros, RN
Title
Executive Director
Phone
(307) 362-1990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 06-088 WY Primary

Addresses

Primary practice location

333 Broadway
Suite 220
Rock Springs, WY 82901-7272

Mailing address

333 Broadway
Suite 220
Rock Springs, WY 82901-7272
Phone (307) 362-1990

Other identifiers 1

IdentifierTypeStateIssuer
1099906 00MedicaidWY

Other names 1

  • Hospice of Sweetwater County, Inc. Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111230000135 WY Part A Provider - Hospice 7113193814 Practice locations: Rock Springs, WY

Hospice certification: CCN 531500

Legal name
HOSPICE OF SWEETWATER COUNTY
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 18, 1987
Last certification
Sep 26, 2019
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Oct 30, 1983 in WY
Enrollment address
333 Broadway St
Ste 220
Rock Springs, WY 82901-6256

National Provider Directory

National Provider Directory

Locations

333 Broadway St
Ste 220
Rock Springs, WY 82901
Phone (307) 362-1990

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.

NameRoleSinceShare
Pamela K Ostdahl Individual Corporate OfficerVice President Jul 1, 2016
Corporate DirectorBoard of Directors Jul 1, 2009
John Hay Individual Corporate DirectorBoard Member Mar 20, 2014
Lori Hall Individual Corporate OfficerTreasurer Jul 1, 2016
Corporate DirectorBoard of Directors Jul 1, 2014
John Kennedy Individual Corporate OfficerPresident Jul 1, 2016
Corporate DirectorBoard President May 1, 2013
Nicole Mandros Individual Corporate OfficerExecutive Director Mar 1, 2017
W-2 Managing EmployeeExecutive Director Mar 1, 2017

Affiliated clinicians 7

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Sweetwater CountyCCN 531500
Ownership
Non-Profit
Certified
Aug 18, 1987
Medicare certification status
ActiveFrom the Provider of Services file

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572912000000",
    "number": "1992767263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 BROADWAY",
            "address_2": "SUITE 220",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829017272",
            "telephone_number": "307-362-1990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 BROADWAY",
            "address_2": "SUITE 220",
            "city": "ROCK SPRINGS",
            "state": "WY",
            "postal_code": "829017272",
            "telephone_number": "307-362-1990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF SWEETWATER COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-03",
        "last_updated": "2019-11-05",
        "status": "A",
        "authorized_official_last_name": "MANDROS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "307-362-1990",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WY",
            "license": "06-088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1099906 00",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of Sweetwater County, Inc.",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Hospice of Sweetwater County, Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Rock Springs, WY

Sources for this page

Verify at the official NPI Registry.