Healthcare Provider Details

I. General information

NPI: 1932072519
Provider Name (Legal Business Name): DEER LODGE NURSING AND REHAB CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 TEXAS AVE
DEER LODGE MT
59722-1829
US

IV. Provider business mailing address

1100 TEXAS AVE
DEER LODGE MT
59722-1829
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-1655
  • Fax:
Mailing address:
  • Phone: 406-846-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DUSTIN MICHAEL MONROE
Title or Position: GENERAL COUNSEL
Credential:
Phone: 385-240-6408