Provider Demographics
NPI:1043749237
Name:PRAIRIE HILLS RECOVERY CENTER
Entity Type:Organization
Organization Name:PRAIRIE HILLS RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LAC
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-488-3001
Mailing Address - Street 1:PO BOX 626
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-0626
Mailing Address - Country:US
Mailing Address - Phone:406-488-3001
Mailing Address - Fax:406-488-3003
Practice Address - Street 1:623 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4216
Practice Address - Country:US
Practice Address - Phone:406-488-3001
Practice Address - Fax:406-488-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2647OtherLICENSED ADDICTION COUNSELOR CERTIFICATE
MT307Medicaid