Healthcare Provider Details

I. General information

NPI: 1467605592
Provider Name (Legal Business Name): FB COMMUNITY HEALTH REPRESENTATIVES PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 05/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 AGENCY MAIN ST
HARLEM MT
59526
US

IV. Provider business mailing address

656 AGENCY MAIN ST
HARLEM MT
59526-9455
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-2525
  • Fax: 406-353-2884
Mailing address:
  • Phone: 406-353-2525
  • Fax: 406-353-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CRAIG CHANDLER
Title or Position: FBIC TRIBAL HEALTH DIRECTOR
Credential:
Phone: 406-353-2525