Provider Demographics
NPI:1770354060
Name:41ST STATE LLC
Entity type:Organization
Organization Name:41ST STATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAGDASAR
Authorized Official - Middle Name:
Authorized Official - Last Name:GALSTYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-866-8998
Mailing Address - Street 1:427 LAKE LOOP DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8705
Mailing Address - Country:US
Mailing Address - Phone:406-866-8998
Mailing Address - Fax:
Practice Address - Street 1:427 LAKE LOOP DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8705
Practice Address - Country:US
Practice Address - Phone:406-866-8998
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-15
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance