Provider Demographics
NPI:1639195613
Name:DANIELS MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:DANIELS MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:DANIELS MEMORIAL HOME HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THANE
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BEDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-487-2296
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MT
Mailing Address - Zip Code:59263-0400
Mailing Address - Country:US
Mailing Address - Phone:406-487-2296
Mailing Address - Fax:406-487-2471
Practice Address - Street 1:105 5TH AVE E
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263
Practice Address - Country:US
Practice Address - Phone:406-487-2296
Practice Address - Fax:406-487-2471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10285251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT277054Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER