Healthcare Provider Details

I. General information

NPI: 1275990269
Provider Name (Legal Business Name): THANKFULLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8250 MT HWY 35 STE 204
BIGFORK MT
59911
US

IV. Provider business mailing address

PO BOX 1893
KALISPELL MT
59903-1893
US

V. Phone/Fax

Practice location:
  • Phone: 406-871-1946
  • Fax: 406-420-2008
Mailing address:
  • Phone: 406-871-1946
  • Fax: 406-420-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number58716
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number58716
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number58716
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number58716
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number58716
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number58716
License Number StateMT
# 7
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number58716
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1710323308
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer

VIII. Authorized Official

Name: MS. ALIDA TINCH
Title or Position: OWNER/PRESIDENT
Credential: CAED
Phone: 406-871-1946