27D0675018 CLIA NUMBER - POWDER RIVER MANOR

Laboratory Demographics

CLIA Number: 27D0675018

Facility Name: POWDER RIVER MANOR

Facility Address:
104 NORTH TRAUTMAN
BROADUS, MT
ZIP 59317
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Facility Phone Number: 406 436-2646

Facility Type: Skilled Nursing Facility/Nursing Facility

Certificate Type: Waiver

NPI Number: 1801234141

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	27D0675018
LAB Type	Skilled Nursing Facility/Nursing Facility
Facility Name	POWDER RIVER MANOR
Street	104 NORTH TRAUTMAN
City	BROADUS
State	MT
ZIP	59317
Phone	406 436-2646
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024