Healthcare Provider Details

I. General information

NPI: 1750376299
Provider Name (Legal Business Name): LANTIS ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 04/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 YELLOWSTONE RIVER RD
BILLINGS MT
59105
US

IV. Provider business mailing address

1415 YELLOWSTONE RIVER RD
BILLINGS MT
59105-1834
US

V. Phone/Fax

Practice location:
  • Phone: 406-245-9330
  • Fax:
Mailing address:
  • Phone: 406-245-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9951
License Number StateMT

VIII. Authorized Official

Name: MICHAEL L. MOORE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 605-642-7736