Organization
COUNTRY HOME ESTATE, INC
Active
Other names
None
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY LYNN NEWMAN (PRESIDENT)
(406) 542-1889
Entity
Organization
Contact information
Practice address
1704 S RESERVE ST, MISSOULA, MT 59801-4752
(406) 542-1889
(406) 549-6848
Mailing address
1704 S RESERVE ST, MISSOULA, MT 59801-4752
(406) 542-1889
(406) 549-6848
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
11069
MT
Other
Enumeration date
04/19/2007
Last updated
09/24/2007
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