Healthcare Provider Details

I. General information

NPI: 1285935924
Provider Name (Legal Business Name): CENTER FOR FAMILY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 10/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 S MONTANA ST
BUTTE MT
59701-2836
US

IV. Provider business mailing address

834 S MONTANA ST
BUTTE MT
59701-2836
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-0123
  • Fax: 406-723-0211
Mailing address:
  • Phone: 406-723-0123
  • Fax: 406-723-0211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number7628
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number33467
License Number StateMT

VIII. Authorized Official

Name: CODA E REYNOLDS
Title or Position: FNP
Credential: FNP
Phone: 406-723-0123