NPIMap

Organization Active NPI

Clark Fork Healthcare, LLC

Doing business as Big Sky Home Health

  • Home Health Agency
  • Missoula, MT
National Provider Identifier
1306641543
Registry record updated Apr 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
CLARK FORK HEALTHCARE, LLC
Doing business as
Big Sky Home Health
Practice address
3760 Mullan Road, Suite 101
Missoula, MT 59808
Phone
(406) 543-4408
Fax
(406) 543-4418
NPI assigned
Feb 13, 2025
Last updated
Apr 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

3760 Mullan Road, Suite 101
Missoula, MT 59808

Mailing address

3760 Mullan Road, Suite 101
Missoula, MT 59808
Phone (406) 543-4408

Other names 1

  • Big Sky Home Health Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250411000255 MT Part A Provider - Home Health Agency 3870923881 Practice locations: Missoula, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306641543. Details of each certification follow.

Home health agency certification: CCN 277303

Legal name
CLARK FORK HEALTHCARE LLC
Doing business as
BIG SKY HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 7, 2025
Last certification
May 30, 2025
Organization structure
LLCProprietary
Enrollment address
3760 Mullan Road, Suite 101
Missoula, MT 59808
HHA Branch

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Big Sky Home HealthCCN 277303 · All quality measures
Ownership
-
Certified
Jul 7, 2025
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D2319333Big Sky Home Health3760 Mullan Road, Suite 101, Missoula, MT 59808Certificate of waiverFeb 25, 2027

National Provider Directory

National Provider Directory
Tax ID family
Big Sky Hospice4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 1, 2025 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate DirectorDirector Mar 1, 2024
Jaimi White Individual W-2 Managing EmployeeAd; Mar 1, 2025
The Pennant Group Inc Organization, Eagle, ID Corporation 5% Or Greater Indirect Ownership Interest Mar 1, 2025 100%
John J Gochnour Individual Corporate OfficerPresident/LLC Manager Mar 1, 2025
Amber Tueller Individual Corporate OfficerSecretary Mar 1, 2025
Elliot McMillan Individual Corporate OfficerVice President Mar 1, 2025

Facilities with the same owner 141

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 141

Practitioners & affiliated clinicians

Affiliated clinicians 24

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1739404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744848000000",
    "number": "1306641543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3760 MULLAN ROAD, SUITE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59808",
            "telephone_number": "406-543-4408",
            "fax_number": "406-543-4418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3760 MULLAN ROAD, SUITE 101",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "59808",
            "telephone_number": "406-543-4408",
            "fax_number": "406-543-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLARK FORK HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-13",
        "last_updated": "2025-04-17",
        "certification_date": "2025-04-11",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Big Sky Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Big Sky Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.