Provider Demographics
NPI:1437588266
Name:ELK MOUNTAIN ACADEMY
Entity type:Organization
Organization Name:ELK MOUNTAIN ACADEMY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEAD OF SCHOOLS
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:THIELBAHR
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:509-723-7251
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-0269
Mailing Address - Country:US
Mailing Address - Phone:360-506-0668
Mailing Address - Fax:208-656-7843
Practice Address - Street 1:54 SERENITY LN
Practice Address - Street 2:
Practice Address - City:HERON
Practice Address - State:MT
Practice Address - Zip Code:59844-9502
Practice Address - Country:US
Practice Address - Phone:406-847-4400
Practice Address - Fax:208-656-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility