Healthcare Provider Details

I. General information

NPI: 1811210578
Provider Name (Legal Business Name): WHITE SKY HOPE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2010
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

IV. Provider business mailing address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax: 406-395-4861
Mailing address:
  • Phone: 406-395-4486
  • Fax: 406-395-4861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number905-10
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateMT

VIII. Authorized Official

Name: TERESA HESTON
Title or Position: APPLICATIONS COORDINATOR
Credential:
Phone: 406-395-4486