Provider Demographics
NPI:1063677417
Name:SHIELDS VALLEY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:SHIELDS VALLEY HEALTH CENTER, INC.
Other - Org Name:CREATIVE NURSING CONCEPTS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:FRANCE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:406-578-2512
Mailing Address - Street 1:309 ELLIOTT STREET NORTH
Mailing Address - Street 2:PO BOX 347
Mailing Address - City:WILSALL
Mailing Address - State:MT
Mailing Address - Zip Code:59086-0347
Mailing Address - Country:US
Mailing Address - Phone:406-578-2580
Mailing Address - Fax:
Practice Address - Street 1:309 ELLIOTT STREET NORTH
Practice Address - Street 2:
Practice Address - City:WILSALL
Practice Address - State:MT
Practice Address - Zip Code:59086-0347
Practice Address - Country:US
Practice Address - Phone:406-578-2580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNONE REQUIRED261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care