Healthcare Provider Details

I. General information

NPI: 1295615177
Provider Name (Legal Business Name): RE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 5TH ST N STE 301
GREAT FALLS MT
59401-3269
US

IV. Provider business mailing address

11 5TH ST N STE 301
GREAT FALLS MT
59401-3269
US

V. Phone/Fax

Practice location:
  • Phone: 406-781-7928
  • Fax:
Mailing address:
  • Phone: 406-781-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: TYSON WILKE
Title or Position: CEO
Credential:
Phone: 406-781-7928