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General NPI Number Information
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NPI Number | 1750684817
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Entity Type | Organization
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Legal Business Name | THE PINES OF POLSON, INC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 405 6TH AVE W
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City | POLSON
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State | MT
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Zip | 59860-2650
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Country | US
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Telephone | 406-560-5786
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Fax |
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Provider Business Mailing Address
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Address Line | 405 6TH AVE W
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City | POLSON
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State | MT
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Zip | 59860-2650
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Country | US
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Telephone | 406-560-5786
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Fax |
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Authorized Official
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Title or Position | OWNER/ADMINISTRATOR
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Name | ILENE S. ARBAUGH
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Credential |
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Telephone | 406-560-5786
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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 | 12475
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License Number State | MT
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