Healthcare Provider Details

I. General information

NPI: 1396997011
Provider Name (Legal Business Name): ALOU ROSE HORINEK LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 664
BOX ELDER MT
59521-9797
US

IV. Provider business mailing address

RR 1 BOX 664
BOX ELDER MT
59521-9797
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4818
  • Fax:
Mailing address:
  • Phone: 406-395-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1264
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number577
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: