Healthcare Provider Details

I. General information

NPI: 1902122427
Provider Name (Legal Business Name): FORT BELKNAP INDIAN COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2010
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: 406-353-8323
  • Fax: 406-353-2276
Mailing address:
  • Phone: 406-353-2205
  • Fax: 406-353-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number901-10
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number902-10
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number902-10
License Number StateMT

VIII. Authorized Official

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