Triple Divide Lodge LLC

Primary specialty

Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X

Legal business name

TRIPLE DIVIDE LODGE LLC

Practice address

200 Hubbart Dam Rd
Marion, MT 59925-9708

Phone

(406) 296-4272

Fax

(406) 854-2835

NPI assigned

Sep 22, 2021

Last updated

Sep 22, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Patrick Hawkins, LAC

Title

Executive Director

Phone

(406) 296-4272

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nathaniel A Moore, LAC

  • Addiction (Substance Use Disorder) Counselor
  • Marion, MT
  • NPI 1518565803
  NPD

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

{
    "created_epoch": "1632268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1104597939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HUBBART DAM RD",
            "city": "MARION",
            "state": "MT",
            "postal_code": "599259708",
            "telephone_number": "406-296-4272",
            "fax_number": "406-854-2835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HUBBART DAM RD",
            "city": "MARION",
            "state": "MT",
            "postal_code": "599259708",
            "telephone_number": "406-296-4272",
            "fax_number": "406-854-2835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIPLE DIVIDE LODGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-22",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "HAWKINS",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "406-296-4272",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Montana Academy, Incorporated
• Nathaniel A Moore, LAC
• Anne E Murphy, LCPC
• John L. Santa, PH.D.
• Melissa Ann Sutton, BSN RN
• Western Montana Works LLC
• Wilderness Alternative School, Inc (Wilderness Treatment Center)

• Substance Use Disorder Rehabilitation Clinic/Center in Marion, MT
• Providers in Marion, MT by specialty
• Substance Use Disorder Rehabilitation Clinic/Center in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; 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.