Provider Demographics
NPI:1376677492
Name:EAGLE PROPERTIES OF GREAT FALLS, LLC
Entity Type:Organization
Organization Name:EAGLE PROPERTIES OF GREAT FALLS, LLC
Other - Org Name:GOLDEN EAGLE PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-453-6521
Mailing Address - Street 1:1501 9TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4531
Mailing Address - Country:US
Mailing Address - Phone:406-453-6521
Mailing Address - Fax:406-453-9983
Practice Address - Street 1:1501 9TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4531
Practice Address - Country:US
Practice Address - Phone:406-453-6521
Practice Address - Fax:406-453-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10018310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0820326Medicaid