Provider Demographics
NPI:1639172489
Name:NORTHWEST HORIZONS, INC.
Entity Type:Organization
Organization Name:NORTHWEST HORIZONS, INC.
Other - Org Name:LOGAN HEALTH BRENDAN HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-752-1724
Mailing Address - Street 1:350 CONWAY DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3148
Mailing Address - Country:US
Mailing Address - Phone:406-751-6500
Mailing Address - Fax:406-751-6544
Practice Address - Street 1:350 CONWAY DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3148
Practice Address - Country:US
Practice Address - Phone:406-751-6500
Practice Address - Fax:406-751-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10271313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT40612OtherBCBS OF MT
MT0310089Medicaid
MT0310089Medicaid