Provider Demographics
NPI:1598197931
Name:UNRAVEL LLC
Entity Type:Organization
Organization Name:UNRAVEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMT, NMT
Authorized Official - Phone:406-754-7721
Mailing Address - Street 1:PO BOX 1194
Mailing Address - Street 2:
Mailing Address - City:CONDON
Mailing Address - State:MT
Mailing Address - Zip Code:59826-1194
Mailing Address - Country:US
Mailing Address - Phone:406-754-7721
Mailing Address - Fax:
Practice Address - Street 1:6295 MT HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:CONDON
Practice Address - State:MT
Practice Address - Zip Code:59826-8702
Practice Address - Country:US
Practice Address - Phone:406-754-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-1253261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center