| NPI | 1710450044 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEAN LYNELLE URS Credentialing Specialist 406-791-9599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-01-09 |