Provider Demographics
NPI:1780992065
Name:THE ELKHORN VIEW
Entity type:Organization
Organization Name:THE ELKHORN VIEW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:MAUREEN
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-431-1107
Mailing Address - Street 1:10 ELKHORN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MONTANA CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9704
Mailing Address - Country:US
Mailing Address - Phone:406-431-1107
Mailing Address - Fax:
Practice Address - Street 1:10 ELKHORN VIEW DR
Practice Address - Street 2:
Practice Address - City:MONTANA CITY
Practice Address - State:MT
Practice Address - Zip Code:59634-9704
Practice Address - Country:US
Practice Address - Phone:406-431-1107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT302R00000X302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization