Provider Demographics
NPI:1710563036
Name:CHANGE ON THE HORIZON
Entity Type:Organization
Organization Name:CHANGE ON THE HORIZON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ADDICTION COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-839-6045
Mailing Address - Street 1:120 YELLOWSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-3239
Mailing Address - Country:US
Mailing Address - Phone:406-839-6045
Mailing Address - Fax:
Practice Address - Street 1:15 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3112
Practice Address - Country:US
Practice Address - Phone:406-561-4337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility