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Organization

HOSPICE OF MISSOULA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GREGORY JACKSON (OWNER)
(406) 543-4408
Entity
Organization

Contact information

Practice address
800 KENSINGTON AVE, SUITE 209, MISSOULA, MT 59801-5674
(406) 543-4408
(406) 543-4418
Mailing address
800 KENSINGTON AVE, SUITE 209, MISSOULA, MT 59801-5674
(406) 543-4408
(406) 543-4418

Taxonomy

Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
9596
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0750210
MT
01
350190
BLUE CROSS BLUE SHIELD
MT
Enumeration date
09/06/2005
Last updated
08/22/2020
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