Provider Demographics
NPI:1366582686
Name:ROCKY MOUNTAIN HOME CARE, INC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESSIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-652-8883
Mailing Address - Street 1:2110 OVERLAND AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6440
Mailing Address - Country:US
Mailing Address - Phone:406-652-8883
Mailing Address - Fax:406-652-8879
Practice Address - Street 1:2110 OVERLAND AVE STE 114
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6440
Practice Address - Country:US
Practice Address - Phone:406-652-8883
Practice Address - Fax:406-652-8879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10570251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT746701Medicaid
MT380198Medicaid
MT620330Medicaid
MT277068Medicare ID - Type UnspecifiedROCKY MOUNTAIN HOME CARE