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1120 Cedar St Missoula MT 59802-3911 | |
| (406) 541-4673 | |
| (406) 327-0042 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1120 Cedar St, Missoula, Montana |
| Authorized Official Name and Position | Andrew Lupo (ASSISTANT FINANCE DIRECTOR) |
| Authorized Official Contact | 4065414673 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1120 Cedar St Missoula MT 59802-3911 Ph: (406) 543-1929 | 1120 Cedar St Missoula MT 59802-3911 Ph: (406) 541-4673 |
| NPI Number | 1164568994 |
|---|---|
| Provider Enumeration Date | 01/29/2007 |
| Last Update Date | 01/03/2024 |
| Certification Date | 01/03/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164568994 | NPI | - | NPPES |
| 0351577 | Medicaid | MT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 10966 (Montana) | Primary |
| 261QR0405X | Clinic/center - Rehabilitation, Substance Use Disorder | (* (Not Available)) | Secondary |
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