Healthcare Provider Details

I. General information

NPI: 1376456392
Provider Name (Legal Business Name): INTEGRATED SPECTRUM HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 8TH AVE NW
RONAN MT
59864-2225
US

IV. Provider business mailing address

PO BOX 1529
POLSON MT
59860-1529
US

V. Phone/Fax

Practice location:
  • Phone: 406-515-9502
  • Fax: 406-676-5512
Mailing address:
  • Phone: 406-515-9502
  • Fax: 406-676-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SARAH DEAVILLE
Title or Position: MEMBER
Credential:
Phone: 406-515-9502