Healthcare Provider Details

I. General information

NPI: 1649374190
Provider Name (Legal Business Name): CULBERTSON FROID BAINVILLE HEALTHCARE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 2ND AVE EAST
CULBERTSON MT
59218-0419
US

IV. Provider business mailing address

PO BOX 419
CULBERTSON MT
59218-0419
US

V. Phone/Fax

Practice location:
  • Phone: 406-787-6401
  • Fax: 406-787-6461
Mailing address:
  • Phone: 406-787-6401
  • Fax: 406-787-6461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10661
License Number StateMT

VII. Legacy identifiers

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

# 1
Identifier0000040312
Identifier TypeOTHER
Identifier StateMT
Identifier IssuerBLUE CROSS BLUE SHIELD
# 2
Identifier310557
Identifier TypeMEDICAID
Identifier StateMT
Identifier Issuer

VIII. Authorized Official

Name: AUDREY STROMBERG
Title or Position: ADMINISTRATOR
Credential:
Phone: 406-787-6401