Provider Demographics
NPI:1306019153
Name:CANADIAN HOMES, INC
Entity Type:Organization
Organization Name:CANADIAN HOMES, INC
Other - Org Name:G&J ENTERPRISES-HANDICAP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLOTTA
Authorized Official - Middle Name:RENIE
Authorized Official - Last Name:HECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-248-5767
Mailing Address - Street 1:3325 DOVE AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-6989
Mailing Address - Country:US
Mailing Address - Phone:406-248-5767
Mailing Address - Fax:406-252-5136
Practice Address - Street 1:3325 DOVE AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-6989
Practice Address - Country:US
Practice Address - Phone:406-248-5767
Practice Address - Fax:406-252-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X, 171WV0202X
MT1171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000229024Medicaid