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General NPI Number Information
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NPI Number | 1043276058
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Entity Type | Organization
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Legal Business Name | HILLSIDE HEALTH CARE CENTER, LLC
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 4720 23RD AVE
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City | MISSOULA
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State | MT
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Zip | 59803-1137
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Country | US
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Telephone | 406-251-5100
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Fax | 406-251-4278
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Provider Business Mailing Address
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Address Line | 1107 HAZELTINE BLVD STE 200
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City | CHASKA
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State | MN
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Zip | 55318-1070
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Country | US
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Telephone | 952-361-8000
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Fax | 952-361-8058
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Authorized Official
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Title or Position | AUTHORIZD OFFICIAL
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Name | MR. JAMES A. WEICHERT
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Credential |
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Telephone | 952-361-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 9917
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License Number State | MT
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