Provider Demographics
NPI:1093817371
Name:COUNTY OF FLATHEAD
Entity Type:Organization
Organization Name:COUNTY OF FLATHEAD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:406-751-6800
Mailing Address - Street 1:736 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-751-6800
Mailing Address - Fax:406-751-6807
Practice Address - Street 1:736 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-5342
Practice Address - Country:US
Practice Address - Phone:406-751-6800
Practice Address - Fax:406-751-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10785251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT740311Medicaid
277011Medicare ID - Type Unspecified