Healthcare Provider Details

I. General information

NPI: 1184806432
Provider Name (Legal Business Name): MONTANA ACADEMY, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 LOST PRAIRIE RD
MARION MT
59925-9844
US

IV. Provider business mailing address

28 W CALIFORNIA ST
KALISPELL MT
59901-3927
US

V. Phone/Fax

Practice location:
  • Phone: 406-858-2339
  • Fax: 406-858-2356
Mailing address:
  • Phone: 406-755-7318
  • Fax: 406-755-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOHN A MCKINNON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 406-755-7318