Provider Demographics
NPI:1043276058
Name:HILLSIDE HEALTH CARE CENTER, LLC
Entity Type:Organization
Organization Name:HILLSIDE HEALTH CARE CENTER, LLC
Other - Org Name:HILLSIDE HEALTH CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZD OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-8000
Mailing Address - Street 1:1107 HAZELTINE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1070
Mailing Address - Country:US
Mailing Address - Phone:952-361-8000
Mailing Address - Fax:952-361-8058
Practice Address - Street 1:4720 23RD AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1137
Practice Address - Country:US
Practice Address - Phone:406-251-5100
Practice Address - Fax:406-251-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9917314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT610116Medicaid
MT0345020Medicaid
MT0217698Medicaid
MT0532844Medicaid
MT0344890Medicaid
MT0310258Medicaid
4074-2OtherBCBS OF MONTANA
MT610116Medicaid