Provider Demographics
NPI:1205286861
Name:CASE MANAGEMENT COLLABORATIVE
Entity type:Organization
Organization Name:CASE MANAGEMENT COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-317-1892
Mailing Address - Street 1:1104 COLOMA DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-7083
Mailing Address - Country:US
Mailing Address - Phone:406-317-1892
Mailing Address - Fax:
Practice Address - Street 1:1104 COLOMA DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7083
Practice Address - Country:US
Practice Address - Phone:406-317-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-15
Last Update Date:2016-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization