Provider Demographics
NPI:1417051632
Name:LIBERTY COUNTY HOSPITAL AND NURSING HOME, INC
Entity Type:Organization
Organization Name:LIBERTY COUNTY HOSPITAL AND NURSING HOME, INC
Other - Org Name:LIBERTY COUNTY HOSPITAL AND NURSING HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RON
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-759-5181
Mailing Address - Street 1:600 WEST MONROE AVE & HWY 223
Mailing Address - Street 2:PO BOX 705
Mailing Address - City:CHESTER
Mailing Address - State:MT
Mailing Address - Zip Code:59522-0705
Mailing Address - Country:US
Mailing Address - Phone:406-759-5181
Mailing Address - Fax:406-759-5799
Practice Address - Street 1:600 WEST MONROE AVE & HWY 223
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MT
Practice Address - Zip Code:59522-0705
Practice Address - Country:US
Practice Address - Phone:406-759-5181
Practice Address - Fax:406-759-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9670314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0312858Medicaid
MT0312858Medicaid