Provider Demographics
NPI:1558435271
Name:KALISPELL REGIONAL MEDICAL CENTER, INC
Entity Type:Organization
Organization Name:KALISPELL REGIONAL MEDICAL CENTER, INC
Other - Org Name:LAKE COUNTY HOME OPTIONS HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR HOME OPTIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HINKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSA
Authorized Official - Phone:406-751-4200
Mailing Address - Street 1:275 CORPORATE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6037
Mailing Address - Country:US
Mailing Address - Phone:406-751-4200
Mailing Address - Fax:406-257-0355
Practice Address - Street 1:711 MAIN ST SW
Practice Address - Street 2:
Practice Address - City:RONAN
Practice Address - State:MT
Practice Address - Zip Code:59864-2502
Practice Address - Country:US
Practice Address - Phone:406-676-7300
Practice Address - Fax:406-676-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10711251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT740180Medicaid
MT740180Medicaid