Provider Demographics
NPI:1902105620
Name:YOUTH HOMES
Entity Type:Organization
Organization Name:YOUTH HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRNBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-721-2704
Mailing Address - Street 1:PO BOX 7616
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7616
Mailing Address - Country:US
Mailing Address - Phone:406-721-2704
Mailing Address - Fax:406-721-0034
Practice Address - Street 1:550 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3913
Practice Address - Country:US
Practice Address - Phone:406-721-2704
Practice Address - Fax:406-721-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7001001320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12050558778Medicaid