Provider Demographics
NPI:1760175145
Name:KALISPELL REHABILITATION AND NURSING LLC
Entity Type:Organization
Organization Name:KALISPELL REHABILITATION AND NURSING LLC
Other - Org Name:KALISPELL REHABILITATION AND NURSING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-498-0195
Mailing Address - Street 1:171 HERITAGE WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3145
Mailing Address - Country:US
Mailing Address - Phone:406-775-0800
Mailing Address - Fax:
Practice Address - Street 1:171 HERITAGE WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3145
Practice Address - Country:US
Practice Address - Phone:406-775-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT13580OtherFACILITY LICENSE