MEDICARE: BEAR PAW RECOVERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1033762992
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAR PAW RECOVERY CENTER

Provider Business Mailing Address
First Line	:	332 2ND AVE
Second Line	:
City	:	HAVRE
State	:	MT
Zip	:	59501-3530
Country	:	US
Telephone Number	:	406-399-1757
Fax Number	:

Provider Business Practice Location Address
First Line	:	332 2ND AVE
Second Line	:
City	:	HAVRE
State	:	MT
Zip	:	59501-3530
Country	:	US
Telephone Number	:	406-399-1757
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSE BERGREN
Credential	:	LAC
Telephone Number	:	406-399-1757

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	09/23/2024

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Directions to “BEAR PAW RECOVERY CENTER ” Practice Location

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