Provider Demographics
NPI:1225106842
Name:FLATHEAD VALLEY CHEMICAL DEPENDENCY CLINIC INC
Entity Type:Organization
Organization Name:FLATHEAD VALLEY CHEMICAL DEPENDENCY CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUMMINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:406-756-6453
Mailing Address - Street 1:PO BOX 7115
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59904-0115
Mailing Address - Country:US
Mailing Address - Phone:406-756-6453
Mailing Address - Fax:406-756-8546
Practice Address - Street 1:1312 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59904-0115
Practice Address - Country:US
Practice Address - Phone:406-756-6453
Practice Address - Fax:406-756-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0320372Medicaid
MT0000076391OtherBLUE CROSS BLUE SHIELD