Basic Information
| Provider Information | |||||||||
| NPI: | 1811954662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY NURSING INC. | ||||||||
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| OtherOrganizationName: | THE VILLAGE HEALTH CARE CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1107 HAZELTINE BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHASKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553181070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9523618000 | ||||||||
| FaxNumber: | 9523618058 | ||||||||
| Practice Location | |||||||||
| Address1: | 2651 SOUTH AVE W | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598046405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067289162 | ||||||||
| FaxNumber: | 4065438128 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| AuthorizedOfficialLastName: | WEICHERT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9523618000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 10068 | MT | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 0310180 | 05 | MT | MEDICAID | 0532519 | 05 | MT | MEDICAID | 4073-2 | 01 | BCBS OF MONTANA | OTHER | 0344760 | 05 | MT | MEDICAID | 0344773 | 05 | MT | MEDICAID | 611494 | 05 | MT | MEDICAID | 0217685 | 05 | MT | MEDICAID |