Healthcare Provider Details

I. General information

NPI: 1003932104
Provider Name (Legal Business Name): THREE RIVERS WILDERNESS PROGRAMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8977 DRY CREEK RD
BELGRADE MT
59714-8121
US

IV. Provider business mailing address

8977 DRY CREEK RD
BELGRADE MT
59714-8121
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-5748
  • Fax: 406-388-5275
Mailing address:
  • Phone: 406-388-5748
  • Fax: 406-388-5275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MARYLLIS FILIPOVICH
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 406-388-5748