Provider Demographics
NPI:1902514052
Name:HYALITE CARE INC.
Entity Type:Organization
Organization Name:HYALITE CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-570-3512
Mailing Address - Street 1:6040 S 3RD RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8904
Mailing Address - Country:US
Mailing Address - Phone:406-570-3512
Mailing Address - Fax:
Practice Address - Street 1:6040 S 3RD RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8904
Practice Address - Country:US
Practice Address - Phone:406-570-3512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1617295Medicaid