Provider Demographics
NPI:1013696442
Name:HEADWATERS HOSPICE AND PALLIATIVE CARE, LLC
Entity Type:Organization
Organization Name:HEADWATERS HOSPICE AND PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-465-0507
Mailing Address - Street 1:11 FRIENDSHIP LN STE 102
Mailing Address - Street 2:
Mailing Address - City:MONTANA CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9805
Mailing Address - Country:US
Mailing Address - Phone:406-422-0114
Mailing Address - Fax:
Practice Address - Street 1:11 FRIENDSHIP LN STE 102
Practice Address - Street 2:
Practice Address - City:MONTANA CITY
Practice Address - State:MT
Practice Address - Zip Code:59634-9805
Practice Address - Country:US
Practice Address - Phone:406-422-0114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based