Organization
MOUNTAIN LODGE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
R JOSEPH RUDE (PRESIDENT)
(406) 655-1883
Entity
Organization
Contact information
Practice address
1110 BIRCH ST, DOUGLAS, WY 82633-2761
(307) 358-1897
Mailing address
1110 BIRCH ST, DOUGLAS, WY 82633-2761
(307) 358-1897
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
02/12/2018
Last updated
02/12/2018
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