Provider Demographics
NPI:1467639617
Name:THE GOTTFRIED HAUS, LLC
Entity Type:Organization
Organization Name:THE GOTTFRIED HAUS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY MEMBER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELOROUS
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-458-6159
Mailing Address - Street 1:5611 GEORGIA DR
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-6804
Mailing Address - Country:US
Mailing Address - Phone:406-458-6159
Mailing Address - Fax:406-458-6159
Practice Address - Street 1:5611 GEORGIA DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6804
Practice Address - Country:US
Practice Address - Phone:406-458-6159
Practice Address - Fax:406-458-6159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11292385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care