MEDICARE: ROCKY MOUNTAIN HOSPICE OF MISSOULA, 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	13548	MT

General Provider Information

NPI Number	:	1437498953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN HOSPICE OF MISSOULA, LLC

Provider Business Mailing Address
First Line	:	10 CADILLAC DRIVE
Second Line	:	SUITE 400
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-1001
Country	:	US
Telephone Number	:	615-377-7022
Fax Number	:	615-373-4457

Provider Business Practice Location Address
First Line	:	2409 DEARBORN AVE
Second Line	:	SUITE E
City	:	MISSOULA
State	:	MT
Zip	:	59801-7586
Country	:	US
Telephone Number	:	406-549-2766
Fax Number	:	406-549-2641

Authorized Official
Title or Position	:	CFO
Name	:	MR. ANTHONY JAMES
Credential	:
Telephone Number	:	615-425-5418

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	01/30/2017

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