Healthcare Provider Details

I. General information

NPI: 1053282897
Provider Name (Legal Business Name): FORT BELKNAP INDIAN COMMUNITY TRIBAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

656 AGENCY MAIN ST
HARLEM MT
59526-9455
US

IV. Provider business mailing address

656 AGENCY MAIN ST
HARLEM MT
59526-9455
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-8470
  • Fax:
Mailing address:
  • Phone: 406-353-8470
  • Fax: 406-353-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: DIANNA BLUE-GAMBLE
Title or Position: PCA PROGRAM MANAGER
Credential: LPN
Phone: 406-353-8470