Provider Demographics
NPI:1104186832
Name:THE WILLOWS
Entity Type:Organization
Organization Name:THE WILLOWS
Other - Org Name:THE SHEPHERD COTTAGE AND THE SOJOURNER COTTAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:406-628-5013
Mailing Address - Street 1:PO BOX 2011
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-2011
Mailing Address - Country:US
Mailing Address - Phone:406-446-1020
Mailing Address - Fax:406-446-0294
Practice Address - Street 1:2475 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068
Practice Address - Country:US
Practice Address - Phone:406-446-1020
Practice Address - Fax:406-446-0294
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOHN'S LUTHERAN MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-29
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12917310400000X
MT12916310400000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility