Organization
YOUTH HOMES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEOFFREY BIRNBAUM (EXECUTIVE DIRECTOR)
(406) 721-2704
Entity
Organization
Contact information
Practice address
550 N CALIFORNIA ST, MISSOULA, MT 59802-3913
(406) 721-2704
(406) 721-0034
Mailing address
PO BOX 7616, MISSOULA, MT 59807-7616
(406) 721-2704
(406) 721-0034
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
7001001
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
12050558778
—
MT
Enumeration date
03/21/2011
Last updated
03/21/2011
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