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General NPI Number Information
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NPI Number | 1306981238
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Entity Type | Organization
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Legal Business Name | KIDS BEHAVIORAL HEALTH OF MONTANA INC
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 06/30/2011
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Provider Practice Location Address
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Address Line | 55 BASIN CREEK RD
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City | BUTTE
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State | MT
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Zip | 59701-9704
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Country | US
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Telephone | 406-494-4183
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Fax | 406-494-1724
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Provider Business Mailing Address
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Address Line | 55 BASIN CREEK RD
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City | BUTTE
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State | MT
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Zip | 59701-9704
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Country | US
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Telephone | 406-494-4183
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Fax | 406-494-1724
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Authorized Official
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Title or Position | CEO
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Name | MR. DAVE M BENNETTS
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Credential |
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Telephone | 406-494-4183
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 10932
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License Number State | MT
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