Healthcare Provider Details

I. General information

NPI: 1558417832
Provider Name (Legal Business Name): BJARKO MFG - ALL ABOUT MOBILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4804 53RD AVE SW
GREAT FALLS MT
59404-4921
US

IV. Provider business mailing address

4804 53RD AVE SW
GREAT FALLS MT
59404-4921
US

V. Phone/Fax

Practice location:
  • Phone: 406-899-9813
  • Fax: 406-761-7062
Mailing address:
  • Phone: 406-899-9813
  • Fax: 406-761-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number45929
License Number StateMT

VIII. Authorized Official

Name: MR. BRYAN BJARKO
Title or Position: OWNER
Credential:
Phone: 406-761-4676