Provider Demographics
NPI:1982660999
Name:INTERGENERATIONAL LIVING & HEALTH CARE, INC
Entity Type:Organization
Organization Name:INTERGENERATIONAL LIVING & HEALTH CARE, INC
Other - Org Name:VALLEY VIEW ESTATES HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSTAFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-8000
Mailing Address - Street 1:1107 HAZELTINE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1009
Mailing Address - Country:US
Mailing Address - Phone:952-361-8000
Mailing Address - Fax:952-361-8058
Practice Address - Street 1:225 N 8TH ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2303
Practice Address - Country:US
Practice Address - Phone:406-363-1144
Practice Address - Fax:406-363-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9735314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0341536Medicaid
MT0530348Medicaid
MT0341562Medicaid
MT610415Medicaid
MT0310167Medicaid
4131-2OtherBCBS OF MONTANA
MT0341562Medicaid