Kismet Red, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10167 Issued in MT

Legal business name

KISMET RED, LLC

Doing business as

Cedar Wood Villa

Practice address

1 S Oaks Ave
Red Lodge, MT 59068

Phone

(406) 446-2525

NPI assigned

Jul 14, 2005

Last updated

Mar 19, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Moore

Title

Cfo

Phone

(605) 642-7736

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Cedar Wood Villa Doing business as

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1326047150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 S OAKES AVE",
            "city": "RED LODGE",
            "state": "MT",
            "postal_code": "590685500",
            "telephone_number": "406-446-2525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 S OAKS AVE",
            "city": "RED LODGE",
            "state": "MT",
            "postal_code": "59068",
            "telephone_number": "406-446-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISMET RED, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-642-7736"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MT",
            "license": "10167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312117",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Wood Villa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cedar Wood Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Red Lodge, MT
• Providers in Red Lodge, MT by specialty
• Skilled Nursing Facility in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.