Provider Demographics
NPI:1811210578
Name:WHITE SKY HOPE CENTER
Entity Type:Organization
Organization Name:WHITE SKY HOPE CENTER
Other - Org Name:ROCKY BOY CHEMICAL DEPENDENCY CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:APPLICATIONS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-395-4486
Mailing Address - Street 1:6850 UPPER BOX ELDER RD
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:MT
Mailing Address - Zip Code:59521-9073
Mailing Address - Country:US
Mailing Address - Phone:406-395-4486
Mailing Address - Fax:406-395-4861
Practice Address - Street 1:6850 UPPER BOX ELDER RD
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-9073
Practice Address - Country:US
Practice Address - Phone:406-395-4486
Practice Address - Fax:406-395-4861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY BOY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-10
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT905-10101YA0400X
MT324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilityGroup - Multi-Specialty