Provider Demographics
NPI:1801437397
Name:JOURNEY TO RECOVERY CENTER
Entity type:Organization
Organization Name:JOURNEY TO RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, BLACKFEET TRIBE
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-338-7391
Mailing Address - Street 1:P.O. BOX 1349
Mailing Address - Street 2:109 N. PUBLIC SQUARE
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417
Mailing Address - Country:US
Mailing Address - Phone:406-338-3123
Mailing Address - Fax:
Practice Address - Street 1:109 N. PUBLIC SQUARE
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-3123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLACKFEET TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-05
Last Update Date:2019-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-LAC-LIC-1293Medicaid