Healthcare Provider Details

I. General information

NPI: 1972476257
Provider Name (Legal Business Name): LDYBOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 3RD AVE N
GREAT FALLS MT
59401-1507
US

IV. Provider business mailing address

1009 3RD AVE N
GREAT FALLS MT
59401-1507
US

V. Phone/Fax

Practice location:
  • Phone: 406-781-4827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: TERRA FISK
Title or Position: OWNER
Credential:
Phone: 406-781-4827