Provider Demographics
NPI:1063758126
Name:BITTERROOT QUALITY CARE, INC.
Entity type:Organization
Organization Name:BITTERROOT QUALITY CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:CRIDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-375-5464
Mailing Address - Street 1:842 NEW YORK AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840
Mailing Address - Country:US
Mailing Address - Phone:406-375-5464
Mailing Address - Fax:406-375-5465
Practice Address - Street 1:842 NEW YORK AVE.
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840
Practice Address - Country:US
Practice Address - Phone:406-375-5464
Practice Address - Fax:406-375-5465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13297310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility