Healthcare Provider Details

I. General information

NPI: 1699613109
Provider Name (Legal Business Name): LDYBOSS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
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: 406-452-6400
  • Fax: 406-452-2250
Mailing address:
  • Phone: 406-452-6400
  • Fax: 406-452-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

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