Provider Demographics
NPI:1205926128
Name:AWE KUALAWAACHE CARE CENTER
Entity type:Organization
Organization Name:AWE KUALAWAACHE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEASEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-638-9111
Mailing Address - Street 1:PO BOX 999
Mailing Address - Street 2:
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022
Mailing Address - Country:US
Mailing Address - Phone:406-638-9111
Mailing Address - Fax:406-638-9119
Practice Address - Street 1:10131 SOUTH HERITAGE RD
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-9111
Practice Address - Fax:406-638-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT310318Medicaid
MT275153Medicare ID - Type Unspecified