Provider Demographics
NPI:1578782447
Name:CHURCHILL RETIREMENT HOME INC.
Entity Type:Organization
Organization Name:CHURCHILL RETIREMENT HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF BOARD
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:DYKSTERHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-282-7291
Mailing Address - Street 1:6151 SHADY REST ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:MT
Mailing Address - Zip Code:59741-8463
Mailing Address - Country:US
Mailing Address - Phone:406-282-7233
Mailing Address - Fax:406-282-7233
Practice Address - Street 1:6151 SHADY REST ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:MT
Practice Address - Zip Code:59741-8463
Practice Address - Country:US
Practice Address - Phone:406-282-7233
Practice Address - Fax:406-282-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10818310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0640832Medicaid