Healthcare Provider Details

I. General information

NPI: 1407339401
Provider Name (Legal Business Name): GLACIER HOPE HOMES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2018
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 HODGSON RD
COLUMBIA FALLS MT
59912-9063
US

IV. Provider business mailing address

390 HODGSON RD
COLUMBIA FALLS MT
59912-9063
US

V. Phone/Fax

Practice location:
  • Phone: 406-871-6738
  • Fax:
Mailing address:
  • Phone: 406-897-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON ADAM STEVENS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-871-6738