Provider Demographics
NPI:1235483728
Name:HOME BASED SERVICES INITIATIVE, LLC
Entity Type:Organization
Organization Name:HOME BASED SERVICES INITIATIVE, LLC
Other - Org Name:SENIOR INDEPENDENCE OF MONTANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-655-5684
Mailing Address - Street 1:3940 RIMROCK ROAD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0141
Mailing Address - Country:US
Mailing Address - Phone:406-655-5800
Mailing Address - Fax:
Practice Address - Street 1:3940 RIMROCK ROAD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0141
Practice Address - Country:US
Practice Address - Phone:406-655-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13206251E00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based