Provider Demographics
NPI:1588653679
Name:ST. JOHN'S LUTHERAN MINISTRIES INC
Entity Type:Organization
Organization Name:ST. JOHN'S LUTHERAN MINISTRIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-655-5684
Mailing Address - Street 1:3940 RIMROCK RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-0141
Mailing Address - Country:US
Mailing Address - Phone:406-655-5600
Mailing Address - Fax:406-655-5656
Practice Address - Street 1:3940 RIMROCK RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0141
Practice Address - Country:US
Practice Address - Phone:406-655-5600
Practice Address - Fax:406-655-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 261QR0400X, 291U00000X
MT10849261QA0600X
MT10024310400000X
MT10959310400000X
MT10938310400000X
MT10910314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No253Z00000XAgenciesIn Home Supportive Care
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No291U00000XLaboratoriesClinical Medical Laboratory
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000621868Medicaid
MT0005602996Medicaid
MT0310206Medicaid
MT0005602996Medicaid