Doctor Name: | MR. JIM CHRISTOPHER MARTINEZ |
NPI Number: | 1740552272 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LAC |
License Number: | 998 |
Business Practice Address: | 4880 Us Highway 93 S Kalispell, MT - 599017985 |
Business Phone Number: | 4068572506 |
Business Fax Number: | 4068572503 |
Mailing Address: | Po Box 2521, COLUMBIA FALLS |
State: | MT |
Postal Code: | 599122521 |
Phone Number: | 4068853607 |
Fax Number: | |
NPI Enumeration Date: | 01/30/2012 |
NPI Last Update Date: | 01/30/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 324500000X |
License Number: | 998 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Substance Abuse Rehabilitation Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |