Healthcare Provider Details

I. General information

NPI: 1710974720
Provider Name (Legal Business Name): TOOLE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 PARK AVE
SHELBY MT
59474-1663
US

IV. Provider business mailing address

PO BOX 915
SHELBY MT
59474-0915
US

V. Phone/Fax

Practice location:
  • Phone: 406-434-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10065
License Number StateMT

VIII. Authorized Official

Name: MS. MARCIA HEYDON
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 406-434-3200