Healthcare Provider Details

I. General information

NPI: 1235951203
Provider Name (Legal Business Name): RILEY EDEN WARREN BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2024
Last Update Date: 10/30/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW HIGGINS AVE SUITE 107
MISSOULA MT
59803
US

IV. Provider business mailing address

700 SW HIGGINS AVE SUITE 107
MISSOULA MT
59803
US

V. Phone/Fax

Practice location:
  • Phone: 406-214-3810
  • Fax: 406-720-7806
Mailing address:
  • Phone: 406-214-3810
  • Fax: 406-720-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: