Healthcare Provider Details

I. General information

NPI: 1164809778
Provider Name (Legal Business Name): CREDENA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50331A US HIGHWAY 93
POLSON MT
59860-7046
US

IV. Provider business mailing address

PO BOX 2704
PORTLAND OR
97208-2704
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-0342
  • Fax: 406-883-0469
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MIKE SKAFI
Title or Position: AVP/SECRETARY
Credential:
Phone: 575-650-3396