Provider Demographics
NPI:1871314922
Name:MONTANA MEMORY MAKERS
Entity type:Organization
Organization Name:MONTANA MEMORY MAKERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAUTHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-250-9651
Mailing Address - Street 1:144 MANY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8390
Mailing Address - Country:US
Mailing Address - Phone:406-250-9651
Mailing Address - Fax:
Practice Address - Street 1:144 MANY LAKES DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-8390
Practice Address - Country:US
Practice Address - Phone:406-250-9651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-22
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty