=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508975616
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIBERTY COUNTY HOSPITAL & NURSING HOME INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 6TH ST W
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59522-7776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-759-5787
-----------------------------------------------------
Fax | 406-759-5012
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 705
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59522-0705
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-759-5181
-----------------------------------------------------
Fax | 406-759-5799
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | CHERIE TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-873-3736
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------