Provider Demographics
NPI:1912001132
Name:LIVINGSTONHEALTHCARE CARDIAC REHAB
Entity Type:Organization
Organization Name:LIVINGSTONHEALTHCARE CARDIAC REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-222-5011
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:406-222-3541
Mailing Address - Fax:406-222-5034
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:406-222-3541
Practice Address - Fax:406-222-5034
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIVINGSTON HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10657282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000099716OtherBCBS CARDIAC REHAB