Healthcare Provider Details

I. General information

NPI: 1356341051
Provider Name (Legal Business Name): GLACIER CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 3RD ST SE
CUT BANK MT
59427
US

IV. Provider business mailing address

707 3RD ST SE
CUT BANK MT
59427-3500
US

V. Phone/Fax

Practice location:
  • Phone: 406-873-5600
  • Fax:
Mailing address:
  • Phone: 406-873-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number12585
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10270
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL MOORE
Title or Position: CFO
Credential:
Phone: 605-642-7736