Healthcare Provider Details

I. General information

NPI: 1760550354
Provider Name (Legal Business Name): MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NORTH BROADWAY
RED LODGE MT
59068-0590
US

IV. Provider business mailing address

PO BOX 590
RED LODGE MT
59068-0590
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-2345
  • Fax: 406-446-0084
Mailing address:
  • Phone: 406-446-2345
  • Fax: 406-446-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number10862
License Number StateMT

VIII. Authorized Official

Name: STEPHANIE BALDWIN
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 406-446-2345