Provider Demographics
NPI:1083738876
Name:INNER-MOUNTAIN FAMILY RESOURCES, INC.
Entity Type:Organization
Organization Name:INNER-MOUNTAIN FAMILY RESOURCES, INC.
Other - Org Name:ADDICTION FAMILY REOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WALLIN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, MSW
Authorized Official - Phone:605-645-2598
Mailing Address - Street 1:23812 COUNTY ROAD 30.5
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-9280
Mailing Address - Country:US
Mailing Address - Phone:645-645-2598
Mailing Address - Fax:719-384-7092
Practice Address - Street 1:608 5TH AVE
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-1214
Practice Address - Country:US
Practice Address - Phone:605-892-3039
Practice Address - Fax:605-892-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD410411324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility