Healthcare Provider Details

I. General information

NPI: 1225305261
Provider Name (Legal Business Name): BOZEMAN PARTNERS LLC -DBA-
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 12/09/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 HUNTERS WAY
BOZEMAN MT
59718
US

IV. Provider business mailing address

111 MARKET STREET NE STE 200
OLYMPIA WA
98501
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-0074
  • Fax:
Mailing address:
  • Phone: 360-867-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number12335
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. EMMETT AARON KOELSCH
Title or Position: MANAGER
Credential:
Phone: 360-867-1900