PANGEA HEALTH SERVICES LLC (NPI# 1124586607) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124586607 |
| Entity Type | Organization |
| Organization Name | PANGEA HEALTH SERVICES LLC |
| Practice Address |
4254 Bordeaux Blvd Missoula MT 59808-9686 |
| Practice Telephone | 4068715814 |
| Practice Fax Number | 4062146334 |
| Mailing Telephone | 4068715814 |
| Mailing Fax Number | 4062146334 |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-04 |
| Authorized Official Name | ASHLEY GUMMER (OWNER) |
| Authorized Official Telephone | 4068715814 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 253Z00000X | In Home Supportive Care | Agencies | ||
| N | 347C00000X | Private Vehicle | Transportation Services | ||
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MT | 0553189 | 05 |
| Other Name | Type Code |
|---|---|
| Pangea Health Services | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PANGEA HEALTH SERVICES LLC | 4254 Bordeaux Blvd, Missoula, MT 59808-9686 |
| Street Address |
4254 BORDEAUX BLVD |
| City | MISSOULA |
| State | MT |
| Zip Code | 59808-9686 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447720875 | Megan Elizabeth Galliford | Behavioral Analyst | 1647 Shindig Dr, Apt 303, Missoula, MT 59808 | 2018-11-28 |
| 1518473560 | Willow Mahana Nelson Griffith | Registered Nurse | 2829 Great Northern Loop Ste 300, Missoula, MT 59808 | 2017-12-28 |
| 1043739428 | Carol Elizabeth Mckenzie | Student in an Organized Health Care Education/Training Program | 2705 Oshaughnessy St, Missoula, MT 59808 | 2017-09-16 |
| 1558884064 | Sharon Marie Herndon | Nurse Practitioner | 2230 N Reserve St Ste 402, Missoula, MT 59808 | 2017-07-18 |
| 1427594761 | Erin Boggs | Specialist/Technologist | 2921 Dublin St, Missoula, MT 59808 | 2017-01-10 |
| 1942603287 | Benjamin Cody Mcintosh | Chiropractor | 1070 N. Russell St., Missoula, MT 59808 | 2014-10-01 |
| 1518219617 | Pure Medical Inc | Ambulance | 5515 Bonanza Place, Missoula, MT 59808 | 2012-10-12 |
| 1932462231 | Kathleen F Calcagno | Specialist/Technologist | 2615 Connery Way, Suite 2b, Missoula, MT 59808 | 2012-06-21 |
| 1639454127 | Dentyn Dunaway | Pharmacist | 2527 N Reserve Street, Missoula, MT 59808 | 2011-10-15 |
| 1750557690 | Carl Thornblade, Md, Pllc | Allergy & Immunology | 2801 Great Northern Loop Ste 101, Missoula, MT 59808 | 2008-04-30 |
| Find all providers in zip 59808 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134641640 | Michelle Moles Lcsw Lac | Community/Behavioral Health | 101 E Broadway St Ste 602, Missoula, MT 59802-4594 | 2017-07-17 |
| 1114160504 | Kristen Kallemeyn | Community/Behavioral Health | 511 Rollins St, Missoula, MT 59801-3720 | 2009-04-14 |
| 1649390881 | Friends To Youth Inc. | Community/Behavioral Health | 1515 E Broadway St, Missoula, MT 59802-4929 | 2007-03-30 |
| 1912079328 | Western Montana Mental Health Center | Community/Behavioral Health | 1321 Wyoming St, Missoula, MT 59801-1725 | 2006-11-14 |
| 1134757198 | Ideal Balance Pllc | Community/Behavioral Health | 2685 Palmer St Ste D, Missoula, MT 59808-1709 | 2020-03-27 |
| 1205390861 | Larissa Olson, Lcsw Pllc | Community/Behavioral Health | 690 Sw Higgins Ave Ste B, Missoula, MT 59803-1433 | 2019-01-29 |
| 1720569213 | Mitch Guerette Lcsw LLC | Community/Behavioral Health | 1001 Sw Higgins Ave Ste 206, Missoula, MT 59803-1340 | 2018-08-23 |
| 1518409846 | Simply Assessments | Community/Behavioral Health | 2798 Meriwether St, Missoula, MT 59803-2934 | 2016-11-17 |
| 1720539745 | Valeo Behavioral Health, LLC | Community/Behavioral Health | 1600 North Ave W Ste 106, Missoula, MT 59801-5500 | 2016-10-14 |
| 1306393194 | Dana Eisenberg, Lcsw Counseling and Consultation, LLC | Community/Behavioral Health | 528 Cleveland St, Missoula, MT 59801-3743 | 2016-09-08 |
| Find all providers in MISSOULA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.