Provider Demographics
NPI:1184806432
Name:MONTANA ACADEMY, INCORPORATED
Entity type:Organization
Organization Name:MONTANA ACADEMY, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-755-7318
Mailing Address - Street 1:28 W CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3927
Mailing Address - Country:US
Mailing Address - Phone:406-755-7318
Mailing Address - Fax:406-755-3150
Practice Address - Street 1:9705 LOST PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:MT
Practice Address - Zip Code:59925-9844
Practice Address - Country:US
Practice Address - Phone:406-858-2339
Practice Address - Fax:406-858-2356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility