1851806590 NPI number — EMMA'S HOUSE CHILDRENS ADVOCACY CENTER

Table of content: RENA MARIE JOHNSON M.D. (NPI 1447267661)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851806590 NPI number — EMMA'S HOUSE CHILDRENS ADVOCACY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMMA'S HOUSE CHILDRENS ADVOCACY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851806590
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2034
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-363-7216
Provider Business Mailing Address Fax Number:
406-363-4036

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 N. 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-363-7216
Provider Business Practice Location Address Fax Number:
406-363-4036
Provider Enumeration Date:
12/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WIDMER
Authorized Official First Name:
VALERIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
406-363-7216

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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