Provider Demographics
NPI:1205048121
Name:BIG SKY HOME CARE SERVICES L.L.C.
Entity type:Organization
Organization Name:BIG SKY HOME CARE SERVICES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-442-2984
Mailing Address - Street 1:1 JACKSON CREEK ROAD
Mailing Address - Street 2:PMB 2197
Mailing Address - City:MONTANA CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59634
Mailing Address - Country:US
Mailing Address - Phone:406-442-2984
Mailing Address - Fax:
Practice Address - Street 1:1 JACKSON CREEK ROAD
Practice Address - Street 2:PMB 2197
Practice Address - City:MONTANA CITY
Practice Address - State:MT
Practice Address - Zip Code:59634
Practice Address - Country:US
Practice Address - Phone:406-442-2984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTC152351251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000471104Medicaid
MT0000651202Medicaid
MT0000380562Medicaid