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General NPI Number Information
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NPI Number | 1154206282
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Entity Type | Organization
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Legal Business Name | MISSOULA INTERFAITH COLLABORATIVE
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Dates
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Enumeration Date | 08/07/2025
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 2205 34TH ST
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City | MISSOULA
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State | MT
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Zip | 59801-8835
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Country | US
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Telephone | 406-207-7052
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 34TH ST
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City | MISSOULA
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State | MT
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Zip | 59801-8835
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Country | US
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Telephone | 406-207-7052
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Fax |
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | ROSE KONDA
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Credential |
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Telephone | 406-426-9669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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