Provider Demographics
NPI:1497754782
Name:LIBERTY COUNTY HOSPITAL AND NURSING HOME, INC
Entity Type:Organization
Organization Name:LIBERTY COUNTY HOSPITAL AND NURSING HOME, INC
Other - Org Name:LIBERTY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-873-2251
Mailing Address - Street 1:PO BOX 705
Mailing Address - Street 2:
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 1:315 WEST MADISON AVENUE
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:2005-07-19
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10273282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT413236Medicaid
271334Medicare ID - Type Unspecified