=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235102013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHERN MONTANA CARE CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2006
-----------------------------------------------------
Last Update Date | 10/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 13TH STREET
-----------------------------------------------------
City | HAVRE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-265-2238
-----------------------------------------------------
Fax | 406-265-9046
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 1231
-----------------------------------------------------
City | HAVRE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-262-1302
-----------------------------------------------------
Fax | 406-265-1651
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | KEVIN HARADA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 406-265-2211
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 10914
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 10914
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------