Provider Demographics
NPI:1588925572
Name:NORTHERN CHEYENNE BOARD OF HEALTH
Entity type:Organization
Organization Name:NORTHERN CHEYENNE BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUNDSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-477-6722
Mailing Address - Street 1:100 CHEYENNE AVENUE.
Mailing Address - Street 2:BOX 67
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:406-477-6722
Mailing Address - Fax:406-477-3038
Practice Address - Street 1:100 CHEYENNE AVENUE
Practice Address - Street 2:BOX 67
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-6722
Practice Address - Fax:406-477-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN28519313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility