# POWELL VALLEY HEALTH CARE INC

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

## Provider details

- **NPI number:** 1932260049
- **Authorized official:** TERRY ODOM (CEO)
- **Authorized official phone:** (307) 754-2267

## Contact information

- **Practice address:** 777 AVENUE H, POWELL, WY 82435-2260
- **Practice address phone:** (307) 754-1101
- **Practice address fax:** (307) 754-3176
- **Mailing address:** 777 AVENUE H, POWELL, WY 82435-2260
- **Mailing address phone:** (307) 754-2267
- **Mailing address fax:** (307) 754-3176

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 07067 | WY | Yes |

## Other

- **Enumeration date:** 12/12/2006
- **Last updated:** 10/23/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 007203 | BCBS PROVIDER \# | WY |
| 05 | — | 107185806 | — | WY |