Provider Demographics
NPI:1588788947
Name:VAN SPYK, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:VAN SPYK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 9TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5708
Mailing Address - Country:US
Mailing Address - Phone:406-761-0829
Mailing Address - Fax:406-761-0829
Practice Address - Street 1:5010 9TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5708
Practice Address - Country:US
Practice Address - Phone:406-761-0829
Practice Address - Fax:406-761-0829
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10291310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility