Basic Information
| Provider Information | |||||||||
| NPI: | 1982660999 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERGENERATIONAL LIVING & HEALTH CARE, INC | ||||||||
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| OtherOrganizationName: | VALLEY VIEW ESTATES HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 HAZELTINE BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | CHASKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553181009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523618000 | ||||||||
| FaxNumber: | 9523618058 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 N 8TH ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598402303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063631144 | ||||||||
| FaxNumber: | 4063637654 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | GUSTAFSON | ||||||||
| AuthorizedOfficialFirstName: | DENISE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9523618000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 9735 | MT | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0341536 | 05 | MT | MEDICAID | 0530348 | 05 | MT | MEDICAID | 0341562 | 05 | MT | MEDICAID | 610415 | 05 | MT | MEDICAID | 0310167 | 05 | MT | MEDICAID | 4131-2 | 01 | BCBS OF MONTANA | OTHER |