Basic Information
| Provider Information | |||||||||
| NPI: | 1689641284 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LIVINGSTON HEALTHCARE | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | LIVINGSTON HEALTHCARE HOME HEALTH AND HOSPICE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 ALPENGLOW LN | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590478506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068236430 | ||||||||
| FaxNumber: | 4068236440 | ||||||||
| Practice Location | |||||||||
| Address1: | 320 ALPENGLOW LN | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590478506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068236430 | ||||||||
| FaxNumber: | 4068236440 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ANCZAK | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4068236411 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 10227 | MT | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0740038 | 05 | MT | MEDICAID | 30300 | 01 | MT | BCBS | OTHER |