Provider Demographics
NPI:1972768414
Name:WILLIAM BELL MONTGOMERY, LLC
Entity Type:Organization
Organization Name:WILLIAM BELL MONTGOMERY, LLC
Other - Org Name:MONTGOMERY GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:1351 OLD HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-9122
Mailing Address - Country:US
Mailing Address - Phone:573-471-1113
Mailing Address - Fax:
Practice Address - Street 1:1351 OLD HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9122
Practice Address - Country:US
Practice Address - Phone:573-471-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility