Healthcare Provider Details

I. General information

NPI: 1285835496
Provider Name (Legal Business Name): RAVALLI SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 PENNSYLVANIA AVE
HAMILTON MT
59840-2036
US

IV. Provider business mailing address

219 PENNSYLVANIA AVE
HAMILTON MT
59840-2036
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-5400
  • Fax: 406-363-5404
Mailing address:
  • Phone: 406-363-5400
  • Fax: 406-363-5404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. MICHAEL SADOWSKI
Title or Position: CEO
Credential:
Phone: 406-363-5400