Healthcare Provider Details

I. General information

NPI: 1023669413
Provider Name (Legal Business Name): RE FAMILY SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 5TH ST N STE 201
GREAT FALLS MT
59401-3269
US

IV. Provider business mailing address

PO BOX 6226
GREAT FALLS MT
59406-6226
US

V. Phone/Fax

Practice location:
  • Phone: 406-204-1487
  • Fax: 406-315-3845
Mailing address:
  • Phone: 406-204-1487
  • Fax: 406-315-3845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: TYSON WILKE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-204-1487