Provider Demographics
NPI:1740963727
Name:MOUNTAIN PINE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:MOUNTAIN PINE ASSISTED LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIEANN
Authorized Official - Middle Name:LAPUZ
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL ASSISTANT
Authorized Official - Phone:406-239-1716
Mailing Address - Street 1:146 CROOKED PINE RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6015
Mailing Address - Country:US
Mailing Address - Phone:406-625-2620
Mailing Address - Fax:
Practice Address - Street 1:146 CROOKED PINE RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6015
Practice Address - Country:US
Practice Address - Phone:406-625-2620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility