Healthcare Provider Details

I. General information

NPI: 1003395278
Provider Name (Legal Business Name): WHITEFISH CARE HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2018
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 7TH ST
WHITEFISH MT
59937-2850
US

IV. Provider business mailing address

5200 N PALM AVE
FRESNO CA
93704-2287
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-3557
  • Fax: 406-862-3557
Mailing address:
  • Phone: 559-901-3147
  • Fax: 559-222-4040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number12679
License Number StateNE

VIII. Authorized Official

Name: BRANDON DAVID BIGELOW
Title or Position: PRESIDENT/CEO
Credential:
Phone: 559-901-3147