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General NPI Number Information
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NPI Number | 1104186832
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Entity Type | Organization
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Legal Business Name | THE WILLOWS
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 02/17/2023
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Provider Practice Location Address
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Address Line | 2475 NORTH BROADWAY
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City | RED LODGE
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State | MT
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Zip | 59068
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Country | US
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Telephone | 406-446-1020
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Fax | 406-446-0294
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Provider Business Mailing Address
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Address Line | PO BOX 2011
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City | RED LODGE
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State | MT
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Zip | 59068-2011
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Country | US
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Telephone | 406-446-1020
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Fax | 406-446-0294
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MICHELLE DEBOER
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Credential | LNHA
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Telephone | 406-628-5013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12917
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12916
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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