Healthcare Provider Details

I. General information

NPI: 1811536105
Provider Name (Legal Business Name): RISING PEAK ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2347 MIDDLE RD
COLUMBIA FALLS MT
59912-9236
US

IV. Provider business mailing address

2347 MIDDLE RD
COLUMBIA FALLS MT
59912-9236
US

V. Phone/Fax

Practice location:
  • Phone: 406-897-8900
  • Fax:
Mailing address:
  • Phone: 406-897-8900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MATT BREKKE
Title or Position: DIRECTOR
Credential:
Phone: 406-897-8900