NPIMap

Organization Active NPI

Lake County Chemical Dependency Program

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Polson, MT
National Provider Identifier
1619909488
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
251 Issued in MT
Legal business name
LAKE COUNTY CHEMICAL DEPENDENCY PROGRAM
Practice address
802 Main St Ste C
Polson, MT 59860-3200
Phone
(406) 883-7310
Fax
(406) 883-7312
NPI assigned
Jul 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Theresa Oakland, M.S. LACNPI 1295766152
Title
Director
Phone
(406) 883-7310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 251 MT Primary

Addresses

Primary practice location

802 Main St Ste C
Polson, MT 59860-3200

Mailing address

802 Main St Ste C
Polson, MT 59860-3200
Phone (406) 883-7310

Other identifiers 2

IdentifierTypeStateIssuer
760850OtherMTBLUE CROSS BLUE SHIELD ID
0320099MedicaidMT

National Provider Directory

National Provider Directory
Tax ID family
Lake County2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 8

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

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1619909488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 MAIN ST STE C",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598603200",
            "telephone_number": "406-883-7310",
            "fax_number": "406-883-7312"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 MAIN ST STE C",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598603200",
            "telephone_number": "406-883-7310",
            "fax_number": "406-883-7312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE COUNTY CHEMICAL DEPENDENCY PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OAKLAND",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "406-883-7310",
        "authorized_official_credential": "M.S. LAC"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MT",
            "license": "251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD ID",
            "identifier": "760850",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0320099",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Polson, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.