Organization
MONTANA SOCIETY INCORPORATED
Active
Other names
The Montana Lodge
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH CHANCE (CEO/PRESIDENT)
(928) 288-2004
Entity
Organization
Contact information
Practice address
1630 SHOUP ST, PRESCOTT, AZ 86305-1343
(928) 227-2448
(928) 268-3433
Mailing address
PO BOX 10835, PRESCOTT, AZ 86304-0835
(928) 515-3350
(928) 268-3433
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
BH3965
AZ
Other
Enumeration date
11/30/2011
Last updated
07/27/2015
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