Healthcare Provider Details

I. General information

NPI: 1104990373
Provider Name (Legal Business Name): YELLOWSTONE BOYS AND GIRLS RANCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 S 72ND ST W
BILLINGS MT
59106-3500
US

IV. Provider business mailing address

1732 S 72ND ST W
BILLINGS MT
59106-3500
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-2100
  • Fax: 406-651-2783
Mailing address:
  • Phone: 406-655-2100
  • Fax: 406-651-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number10810
License Number StateMT
# 5
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number10810
License Number StateMT

VIII. Authorized Official

Name: MR. MIKE CHAVERS
Title or Position: CEO
Credential:
Phone: 406-655-2109