Provider Demographics
NPI:1801005558
Name:MONTANA HOME HEALTH SUPPLIES
Entity Type:Organization
Organization Name:MONTANA HOME HEALTH SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEGARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-899-0900
Mailing Address - Street 1:439 1ST RD S
Mailing Address - Street 2:
Mailing Address - City:FORT SHAW
Mailing Address - State:MT
Mailing Address - Zip Code:59443-9528
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:439 1ST RD S
Practice Address - Street 2:
Practice Address - City:FORT SHAW
Practice Address - State:MT
Practice Address - Zip Code:59443-9528
Practice Address - Country:US
Practice Address - Phone:406-899-0900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT6094850001Medicare NSC