Provider Demographics
NPI:1457498552
Name:BIG SANDY ACTIVITIES, INC.
Entity Type:Organization
Organization Name:BIG SANDY ACTIVITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-378-2598
Mailing Address - Street 1:PO BOX 369
Mailing Address - Street 2:142 GREAT NORTHERN AVE.
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0369
Mailing Address - Country:US
Mailing Address - Phone:406-378-2598
Mailing Address - Fax:406-378-2569
Practice Address - Street 1:142 GREAT NORTHERN AVE.
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520-0369
Practice Address - Country:US
Practice Address - Phone:406-378-2598
Practice Address - Fax:406-378-2569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251C00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services