Healthcare Provider Details

I. General information

NPI: 1205926128
Provider Name (Legal Business Name): AWE KUALAWAACHE CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10131 SOUTH HERITAGE RD
CROW AGENCY MT
59022
US

IV. Provider business mailing address

PO BOX 999
CROW AGENCY MT
59022
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-9111
  • Fax: 406-638-9119
Mailing address:
  • Phone: 406-638-9111
  • Fax: 406-638-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier310318
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer

VIII. Authorized Official

Name: MARIE WEASEL
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 406-638-9111