SUNBURST COMMUNITY SERVICE FOUNDATION, INC (SUNBURST MENTAL HEALTH SERVICES) - NPI NUMBER 1083947055

Summary

Provider Name: SUNBURST COMMUNITY SERVICE FOUNDATION, INC (SUNBURST MENTAL HEALTH SERVICES)

NPI Number: 1083947055

Clasification: Clinic/Center (261QM0850X)

Specialization: Adult Mental Health

Address:
14 RIVER RD
KALISPELL, MT
ZIP 59901

Phone Number: (406) 756-8721



Detailed Information

SUNBURST COMMUNITY SERVICE FOUNDATION, INC is an adult mental health clinic/center in Kalispell, MT. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. The assigned NPI number for this provider is 1083947055 and is registered as an organization entity type.
The provider Is Doing Business As Sunburst Mental Health Services.

The provider's business address is:

14 RIVER RD
KALISPELL, MT
ZIP 59901-823
Phone: (406) 756-8721
Fax: (406) 257-4054

The provider's authorized official is Don Fleck .
The authorized official title is Administrative Director and has the following contact phone number (406) 883-4060.

The enumeration date for this NPI number is 9/9/2009 and was last updated on 5/12/2010.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 261QM0850X Clinic/Center Adult Mental Health No
2 261QM0855X Clinic/Center Adolescent and Children Mental Health No
3 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) Yes

NPI Record

No. Field Name Field Value
1 NPI 1083947055
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name SUNBURST COMMUNITY SERVICE FOUNDATION, INC
5 Provider Other Organization Name SUNBURST MENTAL HEALTH SERVICES
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 14 RIVER RD
8 Provider Business Practice Location Address City Name KALISPELL
9 Provider Business Practice Location Address State Name MT
10 Provider Business Practice Location Address Postal Code 599012823
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 4067568721
13 Provider Business Practice Location Address Fax Number 4062574054
14 Provider Enumeration Date 9/9/2009
15 Last Update Date 5/12/2010
16 Authorized Official Last Name FLECK
17 Authorized Official First Name DON
18 Authorized Official Title or Position ADMINISTRATIVE DIRECTOR
19 Authorized Official Telephone Number 4068834060
20 Healthcare Provider Taxonomy Code 1 261QM0850X
21 Healthcare Provider Primary Taxonomy Switch 1 N
22 Healthcare Provider Taxonomy Code 2 261QM0855X
23 Healthcare Provider Primary Taxonomy Switch 2 N
24 Healthcare Provider Taxonomy Code 3 261QM0801X
25 Healthcare Provider Primary Taxonomy Switch 3 Y
26 Is Organization Subpart N

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This page was last updated on: 4/14/2014
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