Provider Demographics
NPI:1689641284
Name:LIVINGSTON HEALTHCARE
Entity Type:Organization
Organization Name:LIVINGSTON HEALTHCARE
Other - Org Name:LIVINGSTON HEALTHCARE HOME HEALTH AND HOSPICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-823-6411
Mailing Address - Street 1:320 ALPENGLOW LN
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-8506
Mailing Address - Country:US
Mailing Address - Phone:406-823-6430
Mailing Address - Fax:406-823-6440
Practice Address - Street 1:320 ALPENGLOW LN
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-8506
Practice Address - Country:US
Practice Address - Phone:406-823-6430
Practice Address - Fax:406-823-6440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10227251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0740038Medicaid
MT30300OtherBCBS
MT30300OtherBCBS