MEDICARE: KAIROS YOUTH SERVICES, INC.

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
1	320800000X	Mental Illness Community Based Residential Treatment Facility		MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144356791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAIROS YOUTH SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 3066
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59403-3066
Country	:	US
Telephone Number	:	406-727-0076
Fax Number	:	406-452-8382

Provider Business Practice Location Address
First Line	:	4513 7TH AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-1124
Country	:	US
Telephone Number	:	406-771-7774
Fax Number	:	406-452-8382

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES PATRICK CORRIGAN
Credential	:
Telephone Number	:	406-727-0076

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	08/22/2020

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