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STATE OF MONTANA

Intermediate Care Facility, Mental Illness

Lewistown, Montana

Provider NPI: 1528079720

Organization Information:
Organization Name:  STATE OF MONTANA


Practice Location:
800 CASINO CREEK DR  LEWISTOWN, MT 59457 US
Tel: 406-538-7451  Fax: --

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


Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y310500000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mental Illness
MT10746

Other Provider Identifiers:

IssuerNumberStateType
57-2676MT05
57-2546MT05
57-0197MT05
57-0414MT05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin




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