Provider Demographics
| NPI: | 1265556757 |
|---|---|
| Name: | YELLOWSTONE BOYS AND GIRLS RANCH |
| Entity type: | Organization |
| Organization Name: | YELLOWSTONE BOYS AND GIRLS RANCH |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | MIKE |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | CHAVERS |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 406-655-2109 |
| Mailing Address - Street 1: | 1732 S 72ND ST W |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BILLINGS |
| Mailing Address - State: | MT |
| Mailing Address - Zip Code: | 59106-3538 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 406-655-2100 |
| Mailing Address - Fax: | 406-651-2783 |
| Practice Address - Street 1: | 1732 S 72ND ST W |
| Practice Address - Street 2: | |
| Practice Address - City: | BILLINGS |
| Practice Address - State: | MT |
| Practice Address - Zip Code: | 59106 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 406-655-2100 |
| Practice Address - Fax: | 406-651-2783 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-03-19 |
| Last Update Date: | 2025-01-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YM0800X, 1041C0700X, 2084P0800X, 261Q00000X, 261QM0801X, 322D00000X, 363A00000X, 363AM0700X, 363LF0000X | ||
| MT | 1047 | 103T00000X |
| MT | 11000 | 261QM0855X |
| MT | 12265 | 261QM0855X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 322D00000X | Residential Treatment Facilities | Residential Treatment Facility, Emotionally Disturbed Children | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MT | 0039819 | Medicaid | |
| MT | 0255442 | Medicaid | |
| MT | 0350625 | Medicaid | |
| MO | 0502384 | Medicaid | |
| MT | 0502384 | Medicaid | |
| MT | 4302938 | Medicaid | |
| MT | 0042770 | Medicaid | |
| MT | 4309903 | Medicaid | |
| MT | 0069343 | Medicaid |
