Healthcare Provider Details

I. General information

NPI: 1073644902
Provider Name (Legal Business Name): LIBERTY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 09/27/2024
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 EAST ADAMS
CHESTER MT
59522-0459
US

IV. Provider business mailing address

P.O. BOX 459
CHESTER MT
59522-0459
US

V. Phone/Fax

Practice location:
  • Phone: 406-759-8256
  • Fax: 406-759-5923
Mailing address:
  • Phone: 406-759-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. MELISSA MARIE KANTOROWICZ
Title or Position: MANAGER OF LIBERTY COUNTY PUBLIC HE
Credential: RN
Phone: 406-759-8256