# CANYON RIVER STAFFING

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669606943
- **Authorized official:** MS. MAMIE LOU THURSTON RN (PRESIDENT AND OWNER)
- **Authorized official phone:** 13074136909

## Contact information

- **Practice address:** 265 BLAIR DR, APT A, JACKSON, WY 83002
- **Practice address phone:** (130) 741-3690
- **Mailing address:** PO BOX 14622, JACKSON, WY 83002-4622
- **Mailing address phone:** (130) 741-3690

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251J00000X | Nursing Care Agency | 18595 | WY | — |
| 253Z00000X | In Home Supportive Care Agency | 18595 | WY | Yes |

## Other

- **Enumeration date:** 05/14/2009
- **Last updated:** 05/14/2009