MEDICARE: COMMUNITY MEDICAL SERVICES MONTANA-PRIVATE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	251S00000X	Community/Behavioral Health Agency
3	261QM2800X	Methadone Clinic
4	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1891534418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MEDICAL SERVICES MONTANA-PRIVATE, LLC

Provider Business Mailing Address
First Line	:	8444 N 90TH ST STE 100
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85258-4437
Country	:	US
Telephone Number	:	602-248-8886
Fax Number	:

Provider Business Practice Location Address
First Line	:	5130 EVERGREEN WAY
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-2875
Country	:	US
Telephone Number	:	602-248-8886
Fax Number	:

Authorized Official
Title or Position	:	CRED MANAGER
Name	:	ALEJANDRA G VILCHIS
Credential	:
Telephone Number	:	602-248-8886

Provider Enumeration Date	:	05/22/2024
Last Update Date	:	05/22/2024

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