Healthcare Provider Details

I. General information

NPI: 1871031831
Provider Name (Legal Business Name): YELLOWSTONE BOYS AND GIRLS RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 S 72ND ST W
BILLINGS MT
59106
US

IV. Provider business mailing address

1732 S 72ND ST W
BILLINGS MT
59106-3538
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-2142
  • Fax:
Mailing address:
  • Phone: 406-655-2100
  • Fax: 406-656-0021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKE CHAVERS
Title or Position: CEO
Credential:
Phone: 406-655-1209