Healthcare Provider Details

I. General information

NPI: 1215950241
Provider Name (Legal Business Name): HI-LINE RETIREMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S 3RD ST E
MALTA MT
59538-8728
US

IV. Provider business mailing address

801 S 3RD ST E
MALTA MT
59538-8728
US

V. Phone/Fax

Practice location:
  • Phone: 406-654-1190
  • Fax: 406-654-2233
Mailing address:
  • Phone: 406-654-1190
  • Fax: 406-654-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10516
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number10515
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10579
License Number StateMT

VIII. Authorized Official

Name: RICK MIKKELSON
Title or Position: BOARD CHAIRMAN
Credential:
Phone: 406-654-1190