| NPI | 1477218584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMETRIUS FASSAS Executive Director 406-640-8069 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| Enumeration Date | 2021-11-03 |
| Last Update Date | 2022-03-22 |