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Organization

RAE ANN MOXLEY

Active
Other names
Grace Assisted Living
Organization subpart
No

Provider details

NPI number
Authorized official
MS. RAE ANN MOXLEY (SOLE PROPRIETOR)
(406) 293-9980
Entity
Organization

Contact information

Practice address
459 CONIFER RD, LIBBY, MT 59923-2966
(406) 295-9980
Mailing address
459 CONIFER RD, LIBBY, MT 59923-2966
(406) 295-9980

Taxonomy

Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
0044364-001
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0044364-001
MT ST DEPT. OF PUBLIC HEALTH AND HUMAN SERVICES LICENSE FOR ADULT FOSTER HOME
MT
Enumeration date
10/09/2012
Last updated
10/09/2012
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