MEDICARE: THE PINES OF POLSON, 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	12475	MT

General Provider Information

NPI Number	:	1750684817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE PINES OF POLSON, INC

Provider Business Mailing Address
First Line	:	405 6TH AVE W
Second Line	:
City	:	POLSON
State	:	MT
Zip	:	59860-2650
Country	:	US
Telephone Number	:	406-560-5786
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 6TH AVE W
Second Line	:
City	:	POLSON
State	:	MT
Zip	:	59860-2650
Country	:	US
Telephone Number	:	406-560-5786
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	ILENE S. ARBAUGH
Credential	:
Telephone Number	:	406-560-5786

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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Directions to “THE PINES OF POLSON, INC ” Practice Location

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