Basic Information
| Provider Information | |||||||||
| NPI: | 1700312931 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASPEN MEADOWS ASSISTED LIVING, LLC | ||||||||
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| OtherOrganizationName: | ASPEN MEADOWS ASSISTED LIVING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 NE 77TH AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986626736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608926628 | ||||||||
| FaxNumber: | 3608161715 | ||||||||
| Practice Location | |||||||||
| Address1: | 3155 AVENUE C | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591028109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066568818 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2017 | ||||||||
| LastUpdateDate: | 05/09/2017 | ||||||||
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| AuthorizedOfficialLastName: | WEIL | ||||||||
| AuthorizedOfficialFirstName: | BRENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO AND MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3608926628 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | EMPRES MONTANA HEALTHCARE, LLC | ||||||||
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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 | PENDING | 05 | MT | MEDICAID |