Provider Demographics
NPI:1376019000
Name:COTTONWOOD HEALTHCARE, INC.
Entity type:Organization
Organization Name:COTTONWOOD HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SCHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:307-217-3257
Mailing Address - Street 1:1829 MEADOWLARK LN
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-4503
Mailing Address - Country:US
Mailing Address - Phone:307-217-3257
Mailing Address - Fax:307-763-4109
Practice Address - Street 1:304 COFFEEN AVE STE B
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-4803
Practice Address - Country:US
Practice Address - Phone:307-763-4071
Practice Address - Fax:307-763-4109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center