Healthcare Provider Details

I. General information

NPI: 1851439038
Provider Name (Legal Business Name): HKJ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S RESERVE ST PMB 117
MISSOULA MT
59801-6451
US

IV. Provider business mailing address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

V. Phone/Fax

Practice location:
  • Phone: 406-543-1929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10404
License Number StateMT

VIII. Authorized Official

Name: DONNA KAY JENNINGS
Title or Position: OWNER
Credential:
Phone: 406-543-1929