Healthcare Provider Details

I. General information

NPI: 1750404661
Provider Name (Legal Business Name): ALLIANCE OUTREACH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 CAPITAL HEIGHTS DR
BOULDER MT
59632
US

IV. Provider business mailing address

PO BOX 464
BOULDER MT
59632-0464
US

V. Phone/Fax

Practice location:
  • Phone: 406-225-4258
  • Fax: 406-225-3168
Mailing address:
  • Phone: 406-225-4258
  • Fax: 406-225-3168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN BARRAGATO
Title or Position: CO-OWNER
Credential:
Phone: 406-225-4258