Provider Demographics
NPI:1841575453
Name:DISTRICT II ALCOHOL & DRUG PROGRAM
Entity Type:Organization
Organization Name:DISTRICT II ALCOHOL & DRUG PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-377-5942
Mailing Address - Street 1:209 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-4305
Mailing Address - Country:US
Mailing Address - Phone:406-433-4097
Mailing Address - Fax:406-433-4726
Practice Address - Street 1:209 2ND ST SE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-4305
Practice Address - Country:US
Practice Address - Phone:406-433-4097
Practice Address - Fax:406-433-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1382101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty