Provider Demographics
NPI:1336294339
Name:MILK RIVER INC
Entity Type:Organization
Organization Name:MILK RIVER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WETHERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-228-8412
Mailing Address - Street 1:219 2ND AVE S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2314
Mailing Address - Country:US
Mailing Address - Phone:406-228-8412
Mailing Address - Fax:406-228-8148
Practice Address - Street 1:219 2ND AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2314
Practice Address - Country:US
Practice Address - Phone:406-228-8412
Practice Address - Fax:406-228-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services