Provider Demographics
NPI:1467824912
Name:COORDICARE INC
Entity Type:Organization
Organization Name:COORDICARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSING HOME MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MHA
Authorized Official - Phone:406-594-1097
Mailing Address - Street 1:1223 STETSON RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602
Mailing Address - Country:US
Mailing Address - Phone:406-594-1097
Mailing Address - Fax:406-422-4262
Practice Address - Street 1:1223 STETSON RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602
Practice Address - Country:US
Practice Address - Phone:406-594-1097
Practice Address - Fax:406-422-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12731261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12731OtherMT STATE LICENSE