Basic Information
| Provider Information | |||||||||
| NPI: | 1346407830 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELKHORN HEALTH AND REHABILITATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 474 HIGHWAY 282 | ||||||||
| Address2: | |||||||||
| City: | CLANCY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596349519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4069338311 | ||||||||
| FaxNumber: | 4069338391 | ||||||||
| Practice Location | |||||||||
| Address1: | 474 HIGHWAY 282 | ||||||||
| Address2: | |||||||||
| City: | CLANCY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596349519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4069338311 | ||||||||
| FaxNumber: | 4069338391 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2008 | ||||||||
| LastUpdateDate: | 05/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | VOERMANS | ||||||||
| AuthorizedOfficialFirstName: | DULCINEA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4069338311 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | HEALTH MANAGEMENT SERVICES | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1828 | MT | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.