Healthcare Provider Details

I. General information

NPI: 1902514052
Provider Name (Legal Business Name): HYALITE CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 S 3RD RD
BOZEMAN MT
59715-8904
US

IV. Provider business mailing address

6040 S 3RD RD
BOZEMAN MT
59715-8904
US

V. Phone/Fax

Practice location:
  • Phone: 406-570-3512
  • Fax:
Mailing address:
  • Phone: 406-570-3512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: HOLLY GAZY
Title or Position: OWNER
Credential:
Phone: 406-570-3512