Healthcare Provider Details

I. General information

NPI: 1851562664
Provider Name (Legal Business Name): BUTTE PARK ROYAL OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2008
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 NETTIE ST
BUTTE MT
59701-6531
US

IV. Provider business mailing address

2 CROW CANYON CT SUITE 100
SAN RAMON CA
94583-1953
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-3225
  • Fax: 406-723-6470
Mailing address:
  • Phone: 925-362-0354
  • Fax: 925-362-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS R GILL
Title or Position: PRESIDENT
Credential:
Phone: 925-362-0354