Healthcare Provider Details

I. General information

NPI: 1518371244
Provider Name (Legal Business Name): WHEATLAND MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 34TH AVE W
HAVRE MT
59501-6021
US

IV. Provider business mailing address

PO BOX 771
EFFINGHAM IL
62401-0771
US

V. Phone/Fax

Practice location:
  • Phone: 406-265-3111
  • Fax:
Mailing address:
  • Phone: 217-342-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number31471
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SANDRA WILSON
Title or Position: ACCOUNTANT
Credential:
Phone: 217-342-2870