Provider Demographics
NPI:1477218584
Name:BUTTE SPIRIT CENTER
Entity Type:Organization
Organization Name:BUTTE SPIRIT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FASSAS
Authorized Official - Suffix:
Authorized Official - Credentials:CBHPSS
Authorized Official - Phone:406-640-8069
Mailing Address - Street 1:1053 POINT OF ROCKS RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:MT
Mailing Address - Zip Code:59759-9538
Mailing Address - Country:US
Mailing Address - Phone:406-640-8069
Mailing Address - Fax:406-303-5264
Practice Address - Street 1:609 W GALENA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1507
Practice Address - Country:US
Practice Address - Phone:406-640-8069
Practice Address - Fax:406-303-5264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT13587OtherMONTANA DEPARTMENT OF HEALTH AND HUMAN SERVICES LICENSE #