Provider Demographics
NPI:1104212935
Name:CAMBRIDGE OF GREAT FALLS, LLC
Entity Type:Organization
Organization Name:CAMBRIDGE OF GREAT FALLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHELIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLCOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-727-7151
Mailing Address - Street 1:1109 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2242
Mailing Address - Country:US
Mailing Address - Phone:406-727-7151
Mailing Address - Fax:406-727-7024
Practice Address - Street 1:1109 6TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2242
Practice Address - Country:US
Practice Address - Phone:406-727-7151
Practice Address - Fax:406-727-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13335310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility