WESTERN MONTANA MENTAL HEALTH CENTER (NPI# 1306202163) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306202163 |
Entity Type | Organization |
Organization Name | WESTERN MONTANA MENTAL HEALTH CENTER |
Other Organization Name | LAKE HOUSE |
Practice Address |
7 13th Ave East Polson MT 59860 |
Mailing Address |
140 N Russell St Missoula MT 59801-1704 |
Practice Telephone | 4065328400 |
Practice Fax Number | 4065439316 |
Mailing Telephone | 4065328400 |
Mailing Fax Number | 4062244402 |
Enumeration Date | 2016-01-11 |
Last Update Date | 2018-01-25 |
Authorized Official Name | JODI DALY (CEO) |
Authorized Official Telephone | 4065328400 |
Authorized Official Credential | PHD |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 12652 | MT | Residential Treatment Facilities |
Other Name | Type Code |
---|---|
Lake House | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316337264 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 45 East 16th Street, Helena, MT 59601 | 2015-01-30 |
1881973816 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 1273 Dakota St, Missoula, MT 59801-1709 | 2011-08-09 |
1518246552 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 412 Windward Way, Kalispell, MT 59901-2680 | 2011-08-09 |
1528363793 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 1404 Westwood Dr, Hamilton, MT 59840-2315 | 2011-01-20 |
1720382369 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 24 E Copper St, Butte, MT 59701-9302 | 2010-12-22 |
1689976771 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 701 Farmhouse Ln, Bozeman, MT 59715-9419 | 2010-11-23 |
1912079328 | Western Montana Mental Health Center | Community/Behavioral Health | 1321 Wyoming St, Missoula, MT 59801-1725 | 2006-11-14 |
1437529021 | Western Montana Mental Health Center | Substance Abuse Rehabilitation Facility | 1321 Wyoming St, Missoula, MT 59801-1725 | 2015-09-25 |
1548659113 | Western Montana Mental Health Center | Internal Medicine | 1201 Wyoming St, Missoula, MT 59801-1727 | 2015-01-20 |
1164849345 | Western Montana Mental Health Center | Community/Behavioral Health | 1315 Wyoming St, Missoula, MT 59801-1725 | 2014-03-25 |
Street Address |
7 13TH AVE EAST |
City | POLSON |
State | MT |
Zip Code | 59860 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1679095020 | Ashley J Gilham | Registered Nurse | #5 4th Ave E., Polson, MT 59860 | 2017-07-07 |
1225585532 | St. Luke Community Hospital | Clinic/Center | 107 Ridgewater Dr., Polson, MT 59860 | 2016-09-02 |
1154730364 | Wanda L King | Dietitian, Registered | 6 Thirteenth Avenue East, Poslon, MT 59860 | 2014-08-13 |
1104255637 | Dacia Lee Antiste-fisher | Counselor | #5 4th Ave. E., Polson, MT 59860 | 2013-11-05 |
1154758134 | Richard Pierre | Pharmacy Technician | 5 4th Ave E., Polson, MT 59860 | 2013-10-04 |
1154755197 | Wal-mart Stores, Inc | Durable Medical Equipment & Medical Supplies | 36318 Memory Lane, Polson, MT 59860 | 2013-08-27 |
1245582022 | Catherine D Addison | Registered Nurse | 5 4th Ave. East, Polson, MT 59860 | 2012-10-04 |
1114220787 | Erika Ann Weber | Social Worker | #5 4th Ave. E, Polson, MT 59860 | 2010-12-21 |
1942431473 | Lisa L. Scalpane | Counselor | 803 Main Street, Suite C, Polson, MT 59860 | 2009-07-31 |
1477727956 | Bernadette N. Corum | Family Medicine | #5 4th Ave. East, Polson, MT 59860 | 2008-04-16 |
Find all providers in zip 59860 |
Taxonomy Code | 320800000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment Facility, Mental Illness |
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1710450044 | Center for Mental Health | Community Based Residential Treatment Facility, Mental Illness | 626 Central Ave W, Great Falls, MT 59404-2851 | 2019-01-09 |
1215488325 | Ranch for Kids Project, Inc. | Community Based Residential Treatment Facility, Mental Illness | 144 Gateway Street, Rexford, MT 59930 | 2016-10-24 |
1811357767 | New Horizon's Youth Ranch | Community Based Residential Treatment Facility, Mental Illness | 6442 W Kootenai Rd, Rexford, MT 59930-9440 | 2016-03-03 |
1124499660 | Gateway Freedom Ranch | Community Based Residential Treatment Facility, Mental Illness | 111 Glen Lake Dr, Eureka, MT 59917-9680 | 2015-10-09 |
1316337264 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 45 East 16th Street, Helena, MT 59601 | 2015-01-30 |
1568887404 | Selkirk Outdoor Leadership & Education (sole), Inc | Community Based Residential Treatment Facility, Mental Illness | 121 Wisconsin Ave Ste 101, Whitefish, MT 59937-2304 | 2014-03-02 |
1760734149 | Rae Ann Moxley | Community Based Residential Treatment Facility, Mental Illness | 459 Conifer Rd, Libby, MT 59923-2966 | 2012-10-09 |
1881973816 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 1273 Dakota St, Missoula, MT 59801-1709 | 2011-08-09 |
1518246552 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 412 Windward Way, Kalispell, MT 59901-2680 | 2011-08-09 |
1528363793 | Western Montana Mental Health Center | Community Based Residential Treatment Facility, Mental Illness | 1404 Westwood Dr, Hamilton, MT 59840-2315 | 2011-01-20 |
Find all providers with the same taxonomy |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.