Provider Demographics
NPI:1235102013
Name:NORTHERN MONTANA HOSPITAL
Entity Type:Organization
Organization Name:NORTHERN MONTANA HOSPITAL
Other - Org Name:NORTHERN MONTANA CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-262-1302
Mailing Address - Street 1:P.O. BOX 1231
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501
Mailing Address - Country:US
Mailing Address - Phone:406-262-1302
Mailing Address - Fax:406-265-1651
Practice Address - Street 1:24 13TH STREET
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501
Practice Address - Country:US
Practice Address - Phone:406-265-2238
Practice Address - Fax:406-265-9046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2024-04-12
Deactivation Date:2024-03-07
Deactivation Code:
Reactivation Date:2024-03-26
Provider Licenses
StateLicense IDTaxonomies
MT10914313M00000X, 314000000X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000041152OtherBLUE CROSS BLUE SHIELD
MT0310323Medicaid