Provider Demographics
NPI:1215950241
Name:HI-LINE RETIREMENT CENTER
Entity type:Organization
Organization Name:HI-LINE RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKKELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-654-1190
Mailing Address - Street 1:801 S 3RD ST E
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:MT
Mailing Address - Zip Code:59538-8728
Mailing Address - Country:US
Mailing Address - Phone:406-654-1190
Mailing Address - Fax:406-654-2233
Practice Address - Street 1:801 S 3RD ST E
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:MT
Practice Address - Zip Code:59538-8728
Practice Address - Country:US
Practice Address - Phone:406-654-1190
Practice Address - Fax:406-654-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10579310400000X
MT10516314000000X
MT10515385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0700583OtherMEDICAID WAIVER
MT0310930Medicaid
MT275131Medicare ID - Type Unspecified