# US DEPT OF HHS

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

## Provider details

- **NPI number:** 1609143080
- **Authorized official:** WILLIAM WADE OHLSON RN (REGISTERED NURSE)
- **Authorized official phone:** (307) 752-6723

## Contact information

- **Practice address:** 100 CHEYENNE AVE, LAME DEER, MT 59043-0070
- **Practice address phone:** (406) 477-8848
- **Mailing address:** PO BOX 70, LAME DEER, MT 59043-0070
- **Mailing address phone:** (406) 477-8848

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 17679 | WY | Yes |

## Other

- **Enumeration date:** 11/29/2011
- **Last updated:** 11/29/2011