# 1100 TEXAS AVENUE OPERATIONS LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PEAK MEDICAL MONTANA OPERATIONS LLC
- **Other names:** Deer Lodge
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1821043621
- **Legal business name:** PEAK MEDICAL MONTANA OPERATIONS LLC
- **Authorized official:** MICHAEL T. BERG (ASSISTANT SECRETARY)
- **Authorized official phone:** (505) 468-4752

## Contact information

- **Practice address:** 1100 TEXAS AVE, DEER LODGE, MT 59722-1829
- **Practice address phone:** (406) 846-1655
- **Mailing address:** 1100 TEXAS AVE, DEER LODGE, MT 59722-1829
- **Mailing address phone:** (406) 846-1655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 12681 | MT | Yes |

## Other

- **Enumeration date:** 05/23/2006
- **Last updated:** 05/17/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0310250 | — | MT |
| 05 | — | 0347701 | — | MT |
| 05 | — | 0347718 | — | MT |