Provider Demographics
NPI:1356471411
Name:LANTIS ENTERPRISES, INC
Entity Type:Organization
Organization Name:LANTIS ENTERPRISES, INC
Other - Org Name:RIVER RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-7736
Mailing Address - Street 1:1415 YELLOWSTONE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-1834
Mailing Address - Country:US
Mailing Address - Phone:406-245-9330
Mailing Address - Fax:406-245-4219
Practice Address - Street 1:1415 YELLOWSTONE RIVER RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105
Practice Address - Country:US
Practice Address - Phone:406-245-9330
Practice Address - Fax:406-245-4219
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANTIS ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-07
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10737310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0620194Medicaid