Healthcare Provider Details

I. General information

NPI: 1558343202
Provider Name (Legal Business Name): MONTANA MENTAL HEALTH NURSING CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CASINO CREEK DR
LEWISTOWN MT
59457-3359
US

IV. Provider business mailing address

800 CASINO CREEK DR
LEWISTOWN MT
59457-3359
US

V. Phone/Fax

Practice location:
  • Phone: 406-538-7451
  • Fax: 406-538-2863
Mailing address:
  • Phone: 406-538-7451
  • Fax: 406-538-2863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number1038
License Number StateMT

VIII. Authorized Official

Name: MS. DENICE M. MARSHALL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 406-538-7451