Provider Demographics
NPI:1073643060
Name:LANGSTON, ROBERT PRESTON (FOSTER CARE PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:PRESTON
Last Name:LANGSTON
Suffix:
Gender:M
Credentials:FOSTER CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 HWY. 2 W.
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3415
Mailing Address - Country:US
Mailing Address - Phone:406-257-4999
Mailing Address - Fax:
Practice Address - Street 1:1467 HWY. 2 W.
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3415
Practice Address - Country:US
Practice Address - Phone:406-257-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0025821-001177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0621741Medicaid