Provider Demographics
NPI:1316090707
Name:LITTLE BITTERROOT SERVICES, INC.
Entity type:Organization
Organization Name:LITTLE BITTERROOT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSSETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-826-3689
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0189
Mailing Address - Country:US
Mailing Address - Phone:406-826-3689
Mailing Address - Fax:406-826-4245
Practice Address - Street 1:103 W LYNCH
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859
Practice Address - Country:US
Practice Address - Phone:406-826-3689
Practice Address - Fax:406-826-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0010241-001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities