Provider Demographics
NPI:1508975616
Name:LIBERTY COUNTY HOSPITAL & NURSING HOME INC
Entity Type:Organization
Organization Name:LIBERTY COUNTY HOSPITAL & NURSING HOME INC
Other - Org Name:LOGAN HEALTH ASSISTED LIVING - CHESTER
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 1:111 6TH ST W
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MT
Practice Address - Zip Code:59522-7776
Practice Address - Country:US
Practice Address - Phone:406-759-5787
Practice Address - Fax:406-759-5012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0700587Medicaid