Provider Demographics
NPI:1154079366
Name:BIG SKY LIFE SUPPORT
Entity type:Organization
Organization Name:BIG SKY LIFE SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:HCA
Authorized Official - Phone:406-880-0184
Mailing Address - Street 1:8420 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1012
Mailing Address - Country:US
Mailing Address - Phone:406-880-0184
Mailing Address - Fax:406-258-0512
Practice Address - Street 1:8420 PHEASANT DR
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1012
Practice Address - Country:US
Practice Address - Phone:406-880-0184
Practice Address - Fax:406-258-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT251S00000XMedicaid