Provider Demographics
NPI:1033508080
Name:LIBERTY PLACE INC
Entity Type:Organization
Organization Name:LIBERTY PLACE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-287-9887
Mailing Address - Street 1:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MT
Mailing Address - Zip Code:59759-0446
Mailing Address - Country:US
Mailing Address - Phone:406-287-9887
Mailing Address - Fax:
Practice Address - Street 1:313 W LEGION ST
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MT
Practice Address - Zip Code:59759-7762
Practice Address - Country:US
Practice Address - Phone:406-287-9887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13018310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT012154Medicaid