# MOUNTAIN LODGE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437659877
- **Authorized official:** R JOSEPH RUDE (PRESIDENT)
- **Authorized official phone:** (406) 655-1883

## Contact information

- **Practice address:** 1110 BIRCH ST, DOUGLAS, WY 82633-2761
- **Practice address phone:** (307) 358-1897
- **Mailing address:** 1110 BIRCH ST, DOUGLAS, WY 82633-2761
- **Mailing address phone:** (307) 358-1897

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 02/12/2018
- **Last updated:** 02/12/2018