Provider Demographics
NPI:1992075048
Name:MT SILCOX ADULT CARE CENTER
Entity type:Organization
Organization Name:MT SILCOX ADULT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:HENZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-210-1737
Mailing Address - Street 1:PO BOX 1721
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-1721
Mailing Address - Country:US
Mailing Address - Phone:406-210-1737
Mailing Address - Fax:
Practice Address - Street 1:210 SOUTH MADISON STREET
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-1737
Practice Address - Country:US
Practice Address - Phone:406-210-1721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0043361001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home