Healthcare Provider Details

I. General information

NPI: 1306981238
Provider Name (Legal Business Name): KIDS BEHAVIORAL HEALTH OF MONTANA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 BASIN CREEK RD
BUTTE MT
59701-9704
US

IV. Provider business mailing address

55 BASIN CREEK RD
BUTTE MT
59701-9704
US

V. Phone/Fax

Practice location:
  • Phone: 406-494-4183
  • Fax: 406-494-1724
Mailing address:
  • Phone: 406-494-4183
  • Fax: 406-494-1724

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number10932
License Number StateMT

VIII. Authorized Official

Name: MR. DAVE M BENNETTS
Title or Position: CEO
Credential:
Phone: 406-494-4183