Provider Demographics
NPI:1558343202
Name:MONTANA MENTAL HEALTH NURSING CARE CENTER
Entity Type:Organization
Organization Name:MONTANA MENTAL HEALTH NURSING CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-538-7451
Mailing Address - Street 1:800 CASINO CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-3359
Mailing Address - Country:US
Mailing Address - Phone:406-538-7451
Mailing Address - Fax:406-538-2863
Practice Address - Street 1:800 CASINO CREEK DR
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-3359
Practice Address - Country:US
Practice Address - Phone:406-538-7451
Practice Address - Fax:406-538-2863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1038333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT57-1350Medicaid