Healthcare Provider Details

I. General information

NPI: 1619325016
Provider Name (Legal Business Name): HESTIA IN HOME SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW HIGGINS AVE STE 102
MISSOULA MT
59803-1489
US

IV. Provider business mailing address

700 SW HIGGINS AVE STE 102
MISSOULA MT
59803-1489
US

V. Phone/Fax

Practice location:
  • Phone: 406-540-4302
  • Fax: 406-540-4306
Mailing address:
  • Phone: 406-540-4302
  • Fax: 406-540-4306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: THERESA MARIE NOONAN
Title or Position: BILLING SPECIALIST
Credential:
Phone: 406-274-3246