Provider Demographics
NPI:1518615665
Name:CLARK FORK HEALTHCARE, LLC
Entity Type:Organization
Organization Name:CLARK FORK HEALTHCARE, LLC
Other - Org Name:BIG SKY HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:205 HAGGERTY LN STE 120
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8804
Mailing Address - Country:US
Mailing Address - Phone:406-551-2273
Mailing Address - Fax:
Practice Address - Street 1:205 HAGGERTY LN STE 120
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8804
Practice Address - Country:US
Practice Address - Phone:406-551-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health