Provider Demographics
NPI:1396296034
Name:SUNBURST COMMUNITY SERVICE ORGANIZATION
Entity type:Organization
Organization Name:SUNBURST COMMUNITY SERVICE ORGANIZATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLECK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:406-745-3681
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-0703
Mailing Address - Country:US
Mailing Address - Phone:406-745-3681
Mailing Address - Fax:
Practice Address - Street 1:109 1ST AVE
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-0703
Practice Address - Country:US
Practice Address - Phone:406-745-3681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health