Organization
1130 SEVENTEENTH AVENUE OPERATIONS LLC
Active
Other names
Missouri River Center
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
1130 17TH AVE S, GREAT FALLS, MT 59405-4523
(406) 771-4500
Mailing address
1130 17TH AVE S, GREAT FALLS, MT 59405-4523
(406) 771-4500
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
12680
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0534548
—
MT
05
—
310301
—
MT
05
—
3400969
—
MT
05
—
3400982
—
MT
01
—
41502
BC/BS
MT
Enumeration date
06/01/2006
Last updated
05/17/2016
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