Provider Demographics
NPI:1912189572
Name:NORTHEAST MONTANA HEALTH SERVICES,INC
Entity Type:Organization
Organization Name:NORTHEAST MONTANA HEALTH SERVICES,INC
Other - Org Name:FAITH LUTHERAN HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BALAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:512-484-4850
Mailing Address - Street 1:1000 6TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1828
Mailing Address - Country:US
Mailing Address - Phone:406-653-1400
Mailing Address - Fax:406-653-1433
Practice Address - Street 1:1000 6TH AVE N
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1828
Practice Address - Country:US
Practice Address - Phone:406-653-1400
Practice Address - Fax:406-653-1433
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST MONTANA HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-05
Last Update Date:2023-11-05
Deactivation Date:2018-05-16
Deactivation Code:
Reactivation Date:2018-06-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT41032OtherBC/BS
MT0310349Medicaid
MT0310349Medicaid