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STATE OF MONTANA

Intermediate Care Facility, Mentally Retarded

Boulder, Montana

Provider NPI: 1326058207

Organization Information:
Organization Name:  STATE OF MONTANA


Practice Location:
310 FOURTH AVENUE  BOULDER, MT 59632 US
Tel: 406-225-4410  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded
MT10867

Other Provider Identifiers:

IssuerNumberStateType
57-0061MT05
57-0037MT05
57-2598MT05
57-0063MT05
57-0050MT05
57-0095MT05
57-0336MT05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




MENTALLY RETARDED JOBS MT - Page 1



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