- Enrollment id
- O20071005000222
- Enrollment state
- MT
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1851469449
- Multiple npi flag
- N
- Ccn
- 277066
- Associate id
- 1951375849
- Organization name
- MEMORIAL HOSPITAL ASSOCIATION
- Doing business as name
- BEARTOOTH BILLINGS CLINIC
- Incorporation date
- 1992-05-12
- Incorporation state
- MT
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 2525 N BROADWAY AVE
- City
- RED LODGE
- State
- MT
- Zip code
- 590689222