Healthcare Provider Details

I. General information

NPI: 1871314922
Provider Name (Legal Business Name): MONTANA MEMORY MAKERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 MANY LAKES DR
KALISPELL MT
59901-8390
US

IV. Provider business mailing address

144 MANY LAKES DR
KALISPELL MT
59901-8390
US

V. Phone/Fax

Practice location:
  • Phone: 406-250-9651
  • Fax:
Mailing address:
  • Phone: 406-250-9651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: SANDRA RAUTHE
Title or Position: OWNER
Credential:
Phone: 406-250-9651