MEDICARE: NORTH VALLEY HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	12864	MT
2	314000000X	Skilled Nursing Facility	13064	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306837422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH VALLEY HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	63 MAIN ST
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2122
Country	:	US
Telephone Number	:	406-777-5411
Fax Number	:	406-777-5856

Provider Business Practice Location Address
First Line	:	63 MAIN ST
Second Line	:
City	:	STEVENSVILLE
State	:	MT
Zip	:	59870-2122
Country	:	US
Telephone Number	:	406-777-5411
Fax Number	:	406-777-5856

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	MR. BRAD A. SHEFLOE
Credential	:
Telephone Number	:	406-777-5411

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/17/2012

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