Healthcare Provider Details

I. General information

NPI: 1215488325
Provider Name (Legal Business Name): RANCH FOR KIDS PROJECT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 GATEWAY STREET
REXFORD MT
59930
US

IV. Provider business mailing address

PO BOX 116
REXFORD MT
59930-0116
US

V. Phone/Fax

Practice location:
  • Phone: 406-297-7592
  • Fax: 406-297-7592
Mailing address:
  • Phone: 406-297-7592
  • Fax: 406-297-7592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberPAP-PAP-LIC-580
License Number StateMT

VIII. Authorized Official

Name: MR. WILLIAM J SUTLEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-250-0464