| NPI | 1023385390 |
|---|---|
| Doing Business As | THE MONTANA LODGE |
| Entity Type | Organization |
| Authorized Contact | KENNETH CHANCE CEO/President 928-288-2004 |
| Organization Subpart ? | No |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: AZ BH3965) |
| Enumeration Date | 2011-11-30 |
| Last Update Date | 2015-07-27 |