Organization
1100 TEXAS AVENUE OPERATIONS LLC
Active
Parent organization
PEAK MEDICAL MONTANA OPERATIONS LLC
Other names
Deer Lodge
Organization subpart
Yes
Provider details
NPI number
Legal business name
PEAK MEDICAL MONTANA OPERATIONS LLC
Authorized official
MICHAEL T. BERG (ASSISTANT SECRETARY)
(505) 468-4752
Entity
Organization
Contact information
Practice address
1100 TEXAS AVE, DEER LODGE, MT 59722-1829
(406) 846-1655
Mailing address
1100 TEXAS AVE, DEER LODGE, MT 59722-1829
(406) 846-1655
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
12681
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0310250
—
MT
05
—
0347701
—
MT
05
—
0347718
—
MT
Enumeration date
05/23/2006
Last updated
05/17/2016
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