Provider Demographics
NPI:1467605592
Name:FB COMMUNITY HEALTH REPRESENTATIVES PROGRAM
Entity Type:Organization
Organization Name:FB COMMUNITY HEALTH REPRESENTATIVES PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FBIC TRIBAL HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-353-2525
Mailing Address - Street 1:656 AGENCY MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-9455
Mailing Address - Country:US
Mailing Address - Phone:406-353-2525
Mailing Address - Fax:406-353-2884
Practice Address - Street 1:656 AGENCY MAIN ST
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526
Practice Address - Country:US
Practice Address - Phone:406-353-2525
Practice Address - Fax:406-353-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health