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General NPI Number Information
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NPI Number | 1548079973
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Entity Type | Organization
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Legal Business Name | NORTHCARE MONTANA LLC
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Dates
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Enumeration Date | 12/31/2024
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Last Update Date | 12/31/2024
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Provider Practice Location Address
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Address Line | 2814 GREAT NORTHERN LOOP
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City | MISSOULA
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State | MT
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Zip | 59808-1738
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Country | US
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Telephone | 406-543-6183
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Fax |
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Provider Business Mailing Address
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Address Line | 4319 W RAVENNA ST
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City | MERIDIAN
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State | ID
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Zip | 83646-2908
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MAC JONES
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Credential |
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Telephone | 760-815-7203
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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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