Montana Society Incorporated

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

License

BH3965 Issued in AZ

Legal business name

MONTANA SOCIETY INCORPORATED

Doing business as

The Montana Lodge

Practice address

1630 Shoup St
Prescott, AZ 86305-1343

Phone

(928) 227-2448

Fax

(928) 268-3433

NPI assigned

Nov 30, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kenneth Chance

Title

Ceo/President

Phone

(928) 288-2004

Specialties & licenses 1

Addresses

Other names 1

• The Montana Lodge Doing business as

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Arrowhead Lodge

  • Substance Abuse Rehabilitation Facility
  • Prescott, AZ
  • NPI 1043574577
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Klarer, LAC

  • Counselor
  • Phoenix, AZ
  • NPI 1285114413
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437955200000",
    "number": "1023385390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10835",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863040835",
            "telephone_number": "928-515-3350",
            "fax_number": "928-268-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 SHOUP ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863051343",
            "telephone_number": "928-227-2448",
            "fax_number": "928-268-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTANA SOCIETY INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2015-07-27",
        "status": "A",
        "authorized_official_last_name": "CHANCE",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "928-288-2004",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AZ",
            "license": "BH3965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Montana Lodge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debra M Molter, OTR/L
• Alison Momjian, BSN,RN
• Pierre N Momjian, D.P.M.
• Thomas Edward Monachino, MD
• Shane Wylie Monnett, D.O.
• Leticia Montes
• Sergio Gerardo Montes, D.D.S.
• Amy J Montgomery, LAC
• Kathryn Quinn Montoya, LMT
• Monty Shultz Counseling & Neurofeedback LLC

• Substance Abuse Rehabilitation Facility in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Substance Abuse Rehabilitation Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.