MEDICARE: LDYBOSS LLC

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

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	:	1699613109
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LDYBOSS LLC

Provider Business Mailing Address
First Line	:	1009 3RD AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-1507
Country	:	US
Telephone Number	:	406-452-6400
Fax Number	:	406-452-2250

Provider Business Practice Location Address
First Line	:	1009 3RD AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-1507
Country	:	US
Telephone Number	:	406-452-6400
Fax Number	:	406-452-2250

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	TERRA FISK
Credential	:
Telephone Number	:	406-781-4827

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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Directions to “LDYBOSS LLC ” Practice Location

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