Provider Demographics
NPI:1003932104
Name:THREE RIVERS WILDERNESS PROGRAMS, INC.
Entity type:Organization
Organization Name:THREE RIVERS WILDERNESS PROGRAMS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FILIPOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-388-5748
Mailing Address - Street 1:8977 DRY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8121
Mailing Address - Country:US
Mailing Address - Phone:406-388-5748
Mailing Address - Fax:406-388-5275
Practice Address - Street 1:8977 DRY CREEK RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8121
Practice Address - Country:US
Practice Address - Phone:406-388-5748
Practice Address - Fax:406-388-5275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children