1558343202 NPI number — MONTANA MENTAL HEALTH NURSING CARE CENTER

Table of content: (NPI 1558343202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558343202 NPI number — MONTANA MENTAL HEALTH NURSING CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTANA MENTAL HEALTH NURSING CARE CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558343202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 CASINO CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTOWN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59457-3359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-538-7451
Provider Business Mailing Address Fax Number:
406-538-2863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 CASINO CREEK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59457-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-538-7451
Provider Business Practice Location Address Fax Number:
406-538-2863
Provider Enumeration Date:
11/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARSHALL
Authorized Official First Name:
DENICE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
406-538-7451

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  1038 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 57-1350 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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