=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326466202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTANA COMMUNITY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2014
-----------------------------------------------------
Last Update Date | 03/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 993 S 24TH ST W STE B
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-7433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-656-5976
-----------------------------------------------------
Fax | 406-656-0128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 993 S 24TH ST W STE B
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-7433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 406-656-0128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SUPPORT SERVICES DIRECTOR
-----------------------------------------------------
Name | SANDIE SULLINS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-656-5976
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 12617-05
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 12617-06
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 12617-07
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------