Healthcare Provider Details

I. General information

NPI: 1306837422
Provider Name (Legal Business Name): NORTH VALLEY HEALTH CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 MAIN ST
STEVENSVILLE MT
59870-2122
US

IV. Provider business mailing address

63 MAIN ST
STEVENSVILLE MT
59870-2122
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-5411
  • Fax: 406-777-5856
Mailing address:
  • Phone: 406-777-5411
  • Fax: 406-777-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number12864
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number13064
License Number StateMT

VIII. Authorized Official

Name: MR. BRAD A. SHEFLOE
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 406-777-5411