Provider Demographics
NPI:1225429582
Name:KIDS BEHAVIORAL HEALTH OF MONTANA
Entity Type:Organization
Organization Name:KIDS BEHAVIORAL HEALTH OF MONTANA
Other - Org Name:ACADIA MONTANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RHEBA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-497-7890
Mailing Address - Street 1:3738 HARRISON AVE
Mailing Address - Street 2:ALTACARE
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6823
Mailing Address - Country:US
Mailing Address - Phone:406-497-7890
Mailing Address - Fax:406-497-7918
Practice Address - Street 1:3738 HARRISON AVE
Practice Address - Street 2:ALTACARE
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6823
Practice Address - Country:US
Practice Address - Phone:406-497-7890
Practice Address - Fax:406-497-7918
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACADIA HEALTHCARE COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-09
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13178261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0351458Medicaid