Provider Demographics
NPI:1588683866
Name:SWEET MEMORIAL NURSING HOME
Entity type:Organization
Organization Name:SWEET MEMORIAL NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNI
Authorized Official - Middle Name:
Authorized Official - Last Name:PULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-357-2549
Mailing Address - Street 1:PO BOX 1149
Mailing Address - Street 2:
Mailing Address - City:CHINOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59523-1149
Mailing Address - Country:US
Mailing Address - Phone:406-357-2549
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 2 WEST
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:MT
Practice Address - Zip Code:59523
Practice Address - Country:US
Practice Address - Phone:406-357-2549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
MT9960314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0313014Medicaid
MT0313014Medicaid