Provider Demographics
NPI:1417261637
Name:BIG SKY SENIOR LIVING
Entity Type:Organization
Organization Name:BIG SKY SENIOR LIVING
Other - Org Name:BIG SKY SENIOR LIVING COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-737-8906
Mailing Address - Street 1:1701 SOUTH SUTRO TERRACE
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706
Mailing Address - Country:US
Mailing Address - Phone:775-468-6114
Mailing Address - Fax:775-562-4757
Practice Address - Street 1:3701 ELIZABETH WARREN AVE, BIG SKY SENIOR LIVING
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701
Practice Address - Country:US
Practice Address - Phone:406-494-4900
Practice Address - Fax:406-494-6281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000305045Medicaid