Provider Demographics
NPI:1083883490
Name:PARK PLACE WHEEL CHAIR TRANSPORT
Entity Type:Organization
Organization Name:PARK PLACE WHEEL CHAIR TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-761-4300
Mailing Address - Street 1:1500 32ND ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5300
Mailing Address - Country:US
Mailing Address - Phone:406-761-4300
Mailing Address - Fax:406-761-8778
Practice Address - Street 1:1500 32ND ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5300
Practice Address - Country:US
Practice Address - Phone:406-761-4300
Practice Address - Fax:406-761-8778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINDRED NURSING CENTERS WEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0520312Medicaid