Provider Demographics
NPI:1609811306
Name:HILLSIDE HEALTH CARE CENTER, LLC
Entity type:Organization
Organization Name:HILLSIDE HEALTH CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-361-8000
Mailing Address - Street 1:1107 HAZELTINE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1070
Mailing Address - Country:US
Mailing Address - Phone:952-361-8000
Mailing Address - Fax:952-361-8058
Practice Address - Street 1:4718 23RD AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1163
Practice Address - Country:US
Practice Address - Phone:406-251-5100
Practice Address - Fax:406-251-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2017-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10323310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0612482Medicaid
MT840174Medicaid