Provider Demographics
NPI:1437498953
Name:ROCKY MOUNTAIN HOSPICE OF MISSOULA, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HOSPICE OF MISSOULA, LLC
Other - Org Name:COMPASSUS HOSPICE MISSOULA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-425-5418
Mailing Address - Street 1:10 CADILLAC DRIVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-1001
Mailing Address - Country:US
Mailing Address - Phone:615-377-7022
Mailing Address - Fax:615-373-4457
Practice Address - Street 1:2409 DEARBORN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7586
Practice Address - Country:US
Practice Address - Phone:406-549-2766
Practice Address - Fax:406-549-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13548251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT271533Medicare Oscar/Certification