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:
2282 US HIGHWAY 93 S
SUITE #1
KALISPELL, MT
ZIP 59901

Phone Number: (406) 745-3681



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:

2282 US HIGHWAY 93 S
SUITE #1
KALISPELL, MT
ZIP 59901-499
Phone: (406) 745-3681
Fax: (406) 745-3686

The provider's authorized official is Don Fleck .
The authorized official title is Administrative Director and has the following contact phone number (406) 745-3681.

The enumeration date for this NPI number is 9/9/2009 and was last updated on 5/8/2014.

Map - Location of Practice

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 Field Definition 1
1 NPI 1083947055 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name SUNBURST COMMUNITY SERVICE FOUNDATION, INC The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name SUNBURST MENTAL HEALTH SERVICES Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 2282 US HIGHWAY 93 S The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address SUITE #1 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name KALISPELL The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name MT The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 599018499 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 4067453681 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 4067453686 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 9/9/2009 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 5/8/2014 The date that a record was last updated or changed.
17 Authorized Official Last Name FLECK The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name DON The first name of the authorized official.
19 Authorized Official Title or Position ADMINISTRATIVE DIRECTOR The title or position of the authorized official.
20 Authorized Official Telephone Number 4067453681 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 261QM0850X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 261QM0855X
24 Healthcare Provider Primary Taxonomy Switch 2 N
25 Healthcare Provider Taxonomy Code 3 261QM0801X
26 Healthcare Provider Primary Taxonomy Switch 3 Y
27 Is Organization Subpart N

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This page was last updated on: 4/19/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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