| NPI | 1912359639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES LEE WAHLBERG Owner 406-728-8818 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MT 109) |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-07-06 |