MEDICARE: HEADWATERS HOSPICE AND PALLIATIVE CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1013696442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEADWATERS HOSPICE AND PALLIATIVE CARE, LLC

Provider Business Mailing Address
First Line	:	2625 WINNE AVE STE A1
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-4958
Country	:	US
Telephone Number	:	406-422-0114
Fax Number	:	406-324-9190

Provider Business Practice Location Address
First Line	:	2625 WINNE AVE STE A1
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59601-4958
Country	:	US
Telephone Number	:	406-422-0114
Fax Number	:	406-324-9190

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	KRIS MILLER
Credential	:
Telephone Number	:	406-465-0507

Provider Enumeration Date	:	07/13/2023
Last Update Date	:	04/06/2026

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