# PROVIDENCE HEALTH & SERVICES MT

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PROVIDENCE HEALTH & SERVICES
- **Other names:** PROVIDENCE MEDICAL GROUP MONTANA, PMG MT Lng Term Mobility Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1770815276
- **Legal business name:** PROVIDENCE HEALTH & SERVICES
- **Authorized official:** DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
- **Authorized official phone:** (425) 358-9786

## Contact information

- **Practice address:** 500 W BROADWAY ST, MISSOULA, MT 59802-4096
- **Practice address phone:** (406) 329-7870
- **Practice address fax:** (406) 329-7871
- **Mailing address:** PO BOX 31001 - 4114, PASADENA, CA 91110-4114

## Taxonomy

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

## Other

- **Enumeration date:** 02/08/2010
- **Last updated:** 05/07/2025