Healthcare Provider Details

I. General information

NPI: 1447300132
Provider Name (Legal Business Name): REGION IV FAMILY OUTREACH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1236 HELENA AVE
HELENA MT
59601-2948
US

IV. Provider business mailing address

1236 HELENA AVE
HELENA MT
59601-2948
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-3083
  • Fax: 406-443-3209
Mailing address:
  • Phone: 406-443-3083
  • Fax: 406-443-3209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELE PINT
Title or Position: BILLING SPECIALIST
Credential: CMBS
Phone: 406-587-2477