Healthcare Provider Details

I. General information

NPI: 1013754001
Provider Name (Legal Business Name): RAD INDEPENDENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41580 WHISPERING PINES DR
RONAN MT
59864-9337
US

IV. Provider business mailing address

41580 WHISPERING PINES DR
RONAN MT
59864-9337
US

V. Phone/Fax

Practice location:
  • Phone: 406-203-2479
  • Fax:
Mailing address:
  • Phone: 406-203-2479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA D BARNETTE
Title or Position: CHIEF EXECUTIVE OFFICE
Credential:
Phone: 406-203-2479