Organization
HEART MOUNTAIN CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHAY NICOLE BALES CNA (OWNER)
(307) 219-8509
Entity
Organization
Contact information
Practice address
333 S JONES ST LOT 4, POWELL, WY 82435-3103
(307) 219-8509
Mailing address
333 S JONES ST LOT 4, POWELL, WY 82435-3103
(307) 219-8509
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
261QD1600X
Developmental Disabilities Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
310500000X
Mental Illness Intermediate Care Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
12/05/2022
Last updated
12/05/2022
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