Provider Demographics
NPI:1356537120
Name:SUMMIT RANCH INC.
Entity type:Organization
Organization Name:SUMMIT RANCH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE EXECUTIVE DIR.
Authorized Official - Prefix:
Authorized Official - First Name:LIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:AINSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-758-8100
Mailing Address - Street 1:1605 DANIELSON RD.
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-7252
Mailing Address - Country:US
Mailing Address - Phone:406-758-8100
Mailing Address - Fax:406-758-8150
Practice Address - Street 1:1605 DANIELSON RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-7252
Practice Address - Country:US
Practice Address - Phone:406-758-8100
Practice Address - Fax:406-758-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT326261QR0401X
MT23261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)