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NPI Code Detail

MEDICARE: SUNBURST HEALTH LLC

MEDICARE: SUNBURST HEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
2101YP2500XProfessional Counselor
3261QM0850XAdult Mental Health Clinic/Center
4101YA0400XAddiction (Substance Use Disorder) Counselor
5104100000XSocial Worker
6261Q00000XClinic/Center
7363LP0808XPsychiatric/Mental Health Nurse Practitioner
8175T00000XPeer Specialist
9251B00000XCase Management Agency
10363LP2300XPrimary Care Nurse Practitioner
11101YM0800XMental Health Counselor
12261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center
13101Y00000XCounselor
14251S00000XCommunity/Behavioral Health Agency
15261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1093297764
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUNBURST HEALTH LLC
Provider Business Mailing Address
First Line : 2282 US HIGHWAY 93 S
Second Line :
City : KALISPELL
State : MT
Zip : 59901-8499
Country : US
Telephone Number : 406-890-2570
Fax Number : 406-203-9949
Provider Business Practice Location Address
First Line : 2620 CONNERY WAY
Second Line :
City : MISSOULA
State : MT
Zip : 59808-1325
Country : US
Telephone Number : 406-203-9948
Fax Number : 406-203-9949
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : JORDAN STOW
Credential :
Telephone Number : 406-291-0321
Provider Enumeration Date : 08/30/2018
Last Update Date : 11/19/2025

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