Provider Demographics
NPI:1255524674
Name:FRONTIER WYOMING, L.L.C.
Entity type:Organization
Organization Name:FRONTIER WYOMING, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOGUCKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-693-3840
Mailing Address - Street 1:53 RIVER ST
Mailing Address - Street 2:YANKEE PROFESSIONAL BUILDING
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3346
Mailing Address - Country:US
Mailing Address - Phone:203-693-3840
Mailing Address - Fax:203-693-3841
Practice Address - Street 1:907 N POPLAR ST
Practice Address - Street 2:SUITE 277
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1320
Practice Address - Country:US
Practice Address - Phone:307-234-6684
Practice Address - Fax:307-234-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1255524674Medicaid
WY537044Medicare Oscar/Certification