Healthcare Provider Details

I. General information

NPI: 1568114387
Provider Name (Legal Business Name): COMMUNITARIAN PROJECT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 01/23/2022
Certification Date: 01/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73342 LILAC FLOWER LN
ARLEE MT
59821-9463
US

IV. Provider business mailing address

73342 LILAC FLOWER LN
ARLEE MT
59821-9463
US

V. Phone/Fax

Practice location:
  • Phone: 406-240-5562
  • Fax:
Mailing address:
  • Phone: 406-240-5562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: BAYLIN CRAYTHORN
Title or Position: TREASURER
Credential:
Phone: 406-240-5562