Healthcare Provider Details

I. General information

NPI: 1013102425
Provider Name (Legal Business Name): GREENWOOD ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 GREENWOOD AVE E
BUTTE MT
59701-5263
US

IV. Provider business mailing address

5 GREENWOOD AVE E
BUTTE MT
59701-5263
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-9004
  • Fax: 406-782-9004
Mailing address:
  • Phone: 406-782-9004
  • Fax: 406-782-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10859
License Number StateMT

VIII. Authorized Official

Name: MS. JULIE TERESA KINDT I
Title or Position: ADMINISTRATOR
Credential: B.S.N.
Phone: 406-782-9004