Provider Demographics
NPI:1144366246
Name:DISTRICT II ALCOHOL AND DRUG PROGRAM
Entity type:Organization
Organization Name:DISTRICT II ALCOHOL AND DRUG PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SCHLEPP
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LAC
Authorized Official - Phone:406-377-5942
Mailing Address - Street 1:119 S KENDRICK AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1626
Mailing Address - Country:US
Mailing Address - Phone:406-377-5942
Mailing Address - Fax:406-377-3050
Practice Address - Street 1:119 S KENDRICK AVE
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1626
Practice Address - Country:US
Practice Address - Phone:406-377-5942
Practice Address - Fax:406-377-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT211-07101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT320042Medicaid
MT76361OtherBCBS PROVIDEER NUMBER