Provider Demographics
NPI:1306837422
Name:NORTH VALLEY HEALTH CARE, INC.
Entity Type:Organization
Organization Name:NORTH VALLEY HEALTH CARE, INC.
Other - Org Name:THE LIVINGCENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEFLOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-777-5411
Mailing Address - Street 1:63 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-2122
Mailing Address - Country:US
Mailing Address - Phone:406-777-5411
Mailing Address - Fax:406-777-5856
Practice Address - Street 1:63 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2122
Practice Address - Country:US
Practice Address - Phone:406-777-5411
Practice Address - Fax:406-777-5856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12864310400000X
MT13064314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT310609Medicaid
MT275125Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER