=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073500872
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COONEY HEALTH CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2005
-----------------------------------------------------
Last Update Date | 11/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2555 E BROADWAY ST
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-4990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-447-1651
-----------------------------------------------------
Fax | 406-447-1653
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2555 E BROADWAY ST
-----------------------------------------------------
City | HELENA
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59601-4990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-447-1651
-----------------------------------------------------
Fax | 406-447-1654
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRENDAN FOLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 860-989-5053
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 10431
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------