Healthcare Provider Details

I. General information

NPI: 1205042355
Provider Name (Legal Business Name): SANDERS COUNTY COUNCIL ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 WALL ST SUITE 3
HOT SPRINGS MT
59845-0339
US

IV. Provider business mailing address

PO BOX 339
HOT SPRINGS MT
59845-0339
US

V. Phone/Fax

Practice location:
  • Phone: 406-741-2343
  • Fax: 406-741-2349
Mailing address:
  • Phone: 406-741-2343
  • Fax: 406-741-2349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: GWEN MARIE HANSON
Title or Position: DIRECTOR
Credential:
Phone: 406-741-2343