Healthcare Provider Details

I. General information

NPI: 1871971044
Provider Name (Legal Business Name): HEALTHCENTER NORTHWEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

320 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-4720
  • Fax: 406-751-5430
Mailing address:
  • Phone: 406-756-4720
  • Fax: 406-751-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MR. TATE KREITINGER
Title or Position: CEO
Credential:
Phone: 406-751-6991