Healthcare Provider Details

I. General information

NPI: 1760108609
Provider Name (Legal Business Name): ALL NATIONS HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 11/08/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 S RUSSELL ST
MISSOULA MT
59801-3629
US

IV. Provider business mailing address

2100 STEPHENS AVE STE 105
MISSOULA MT
59801-6607
US

V. Phone/Fax

Practice location:
  • Phone: 406-829-9515
  • Fax:
Mailing address:
  • Phone: 406-829-9515
  • Fax: 406-829-9519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIANA DAVIS
Title or Position: DIRECTOR OF HUMAN RESOURCES
Credential:
Phone: 406-829-9515