Healthcare Provider Details

I. General information

NPI: 1033762992
Provider Name (Legal Business Name): BEAR PAW RECOVERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 2ND AVE
HAVRE MT
59501-3530
US

IV. Provider business mailing address

332 2ND AVE
HAVRE MT
59501-3530
US

V. Phone/Fax

Practice location:
  • Phone: 406-399-1757
  • Fax:
Mailing address:
  • Phone: 406-399-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: JESSE BERGREN
Title or Position: OWNER
Credential: LAC
Phone: 406-399-1757