Provider Demographics
NPI:1720513674
Name:CROW NATION RECOVERY CENTER
Entity Type:Organization
Organization Name:CROW NATION RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JEROLD
Authorized Official - Last Name:BIG HAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-679-5351
Mailing Address - Street 1:101 BAACHEEITCCHE AVE
Mailing Address - Street 2:BUILDING #20
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022
Mailing Address - Country:US
Mailing Address - Phone:406-679-5351
Mailing Address - Fax:
Practice Address - Street 1:101 BAACHEEITCHE
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-679-5351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder