MEDICARE: VIA VITA LLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1144519083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIA VITA LLC

Provider Business Mailing Address
First Line	:	PO BOX 1048
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59403-1048
Country	:	US
Telephone Number	:	406-771-5030
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 1ST AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2506
Country	:	US
Telephone Number	:	406-771-5030
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	KAREN PEDEW
Credential	:
Telephone Number	:	406-771-5030

Provider Enumeration Date	:	03/31/2011
Last Update Date	:	03/31/2011

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