Healthcare Provider Details

I. General information

NPI: 1487711487
Provider Name (Legal Business Name): COUNTY OF SWEET GRASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 WEST 7TH AVE SUITE L
BIG TIMBER MT
59011
US

IV. Provider business mailing address

PO BOX 1228
BIG TIMBER MT
59011-1228
US

V. Phone/Fax

Practice location:
  • Phone: 406-932-4603
  • Fax: 406-932-5468
Mailing address:
  • Phone: 406-932-4603
  • Fax: 406-932-5468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10786
License Number StateMT

VIII. Authorized Official

Name: ERIK WOOD
Title or Position: CEO
Credential:
Phone: 406-932-4603