| NPI | 1568837730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEIGH TABOR FAHLQUIST Owner 406-465-1276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MT 1005) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |