Organization
CANYON RIVER STAFFING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MAMIE LOU THURSTON RN (PRESIDENT AND OWNER)
13074136909
Entity
Organization
Contact information
Practice address
265 BLAIR DR, APT A, JACKSON, WY 83002
(130) 741-3690
Mailing address
PO BOX 14622, JACKSON, WY 83002-4622
(130) 741-3690
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
18595
WY
253Z00000X
In Home Supportive Care Agency
Primary
18595
WY
Other
Enumeration date
05/14/2009
Last updated
05/14/2009
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