Provider Demographics
NPI:1942533955
Name:INDIAN FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:INDIAN FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:406-268-1587
Mailing Address - Street 1:1220 CENTRAL AVE
Mailing Address - Street 2:STE 1A
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3764
Mailing Address - Country:US
Mailing Address - Phone:406-268-1587
Mailing Address - Fax:406-268-1914
Practice Address - Street 1:1220 CENTRAL AVE
Practice Address - Street 2:STE 1A
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3764
Practice Address - Country:US
Practice Address - Phone:406-268-1587
Practice Address - Fax:406-268-1914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder