Provider Demographics
NPI:1629475256
Name:GRANDMA'S HOUSE INC.
Entity Type:Organization
Organization Name:GRANDMA'S HOUSE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BILBREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-531-8758
Mailing Address - Street 1:2327 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-1124
Mailing Address - Country:US
Mailing Address - Phone:406-251-7101
Mailing Address - Fax:
Practice Address - Street 1:2327 39TH ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1124
Practice Address - Country:US
Practice Address - Phone:406-251-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11954310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility