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General NPI Number Information
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NPI Number | 1740963727
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Entity Type | Organization
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Legal Business Name | MOUNTAIN PINE ASSISTED LIVING LLC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/28/2023
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Provider Practice Location Address
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Address Line | 146 CROOKED PINE RD
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City | STEVENSVILLE
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State | MT
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Zip | 59870-6015
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Country | US
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Telephone | 406-625-2620
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Fax |
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Provider Business Mailing Address
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Address Line | 146 CROOKED PINE RD
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City | STEVENSVILLE
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State | MT
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Zip | 59870-6015
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Country | US
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Telephone | 406-625-2620
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MISS JULIEANN LAPUZ MOSS
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Credential | MEDICAL ASSISTANT
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Telephone | 406-239-1716
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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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