Provider Demographics
NPI:1982928446
Name:HOSPICE OF SOUTHWEST MONTANA, LLC
Entity Type:Organization
Organization Name:HOSPICE OF SOUTHWEST MONTANA, LLC
Other - Org Name:ENHABIT HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CRISSY
Authorized Official - Middle Name:BUCHANAN
Authorized Official - Last Name:CARLISLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-239-6500
Mailing Address - Street 1:53 RIVER ST
Mailing Address - Street 2:YANKEE PROFESSIONAL BUILDING
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3346
Mailing Address - Country:US
Mailing Address - Phone:203-693-3840
Mailing Address - Fax:203-693-3841
Practice Address - Street 1:3810 VALLEY COMMONS DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6477
Practice Address - Country:US
Practice Address - Phone:406-585-1099
Practice Address - Fax:406-585-1073
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENHABIT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-26
Last Update Date:2022-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1982928446Medicaid
271509Medicare Oscar/Certification