1130 Seventeenth Avenue Operations LLC

NPI #1063459501 in Great Falls, Montana

Provider Information

NPI Number
1063459501
Entity Type
Organization
Organization Name
1130 Seventeenth Avenue Operations LLC
Primary Specialty
Skilled Nursing Facility
Enumeration Date
Jun 1, 2006
Last Updated
May 17, 2016

Practice Location

Address
1130 17TH AVE S
State
Montana
ZIP Code
59405-4523
Phone
(406) 771-4500

Authorized Official

Name
MICHAEL T. BERG
Title
ASSISTANT SECRETARY
Phone
(505) 468-4752

Specialties & Taxonomy Codes

Specialty
Skilled Nursing Facility

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