Provider Demographics
NPI:1194837237
Name:PLAINS HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:PLAINS HOSPITAL CORPORATION
Other - Org Name:CLARK FORK VALLEY NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-826-4814
Mailing Address - Street 1:10 KRUGER RD
Mailing Address - Street 2:PO BOX 768
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-9506
Mailing Address - Country:US
Mailing Address - Phone:406-826-4816
Mailing Address - Fax:406-826-4898
Practice Address - Street 1:10 KRUGER RD
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-9506
Practice Address - Country:US
Practice Address - Phone:406-826-4816
Practice Address - Fax:406-826-4849
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAINS HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10608314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT311727Medicaid
MT311727Medicaid