Healthcare Provider Details

I. General information

NPI: 1609811306
Provider Name (Legal Business Name): HILLSIDE HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 10/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 23RD AVE SUITE 300
MISSOULA MT
59803-1163
US

IV. Provider business mailing address

1107 HAZELTINE BLVD STE 200
CHASKA MN
55318-1070
US

V. Phone/Fax

Practice location:
  • Phone: 406-251-5100
  • Fax: 406-251-4278
Mailing address:
  • Phone: 952-361-8000
  • Fax: 952-361-8058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10323
License Number StateMT

VIII. Authorized Official

Name: MR. JAMES A WEICHERT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 952-361-8000