Basic Information
| Provider Information | |||||||||
| NPI: | 1417261637 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIG SKY SENIOR LIVING | ||||||||
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| OtherOrganizationName: | BIG SKY SENIOR LIVING COMMUNITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1701 SOUTH SUTRO TERRACE | ||||||||
| Address2: | |||||||||
| City: | CARSON CITY | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7754686114 | ||||||||
| FaxNumber: | 7755624757 | ||||||||
| Practice Location | |||||||||
| Address1: | 3701 ELIZABETH WARREN AVE, BIG SKY SENIOR LIVING | ||||||||
| Address2: | |||||||||
| City: | BUTTE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064944900 | ||||||||
| FaxNumber: | 4064946281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2010 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | FISHER | ||||||||
| AuthorizedOfficialFirstName: | DARRYL | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7757378906 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | MT | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 0000305045 | 05 | MT | MEDICAID |