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General NPI Number Information
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NPI Number | 1114892585
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Entity Type | Organization
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Legal Business Name | PROACTIVE LIVING FACILITY: JAKE'S FARM IN THE DELL
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1005 AUTISM LN
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City | RONAN
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State | MT
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Zip | 59864-2847
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Country | US
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Telephone | 406-515-9850
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 AUTISM LN
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City | RONAN
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State | MT
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Zip | 59864-2847
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Country | US
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Telephone | 406-515-9850
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DENNIS TONEY
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Credential | MS
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Telephone | 406-515-9850
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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 |
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License Number State |
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