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NPI Code Detail

MEDICARE: INTERMOUNTAIN DEACONESS HOME FOR CHILDREN

MEDICARE: INTERMOUNTAIN DEACONESS HOME FOR CHILDREN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor11075MT
21041C0700XClinical Social Worker11075MT
3251B00000XCase Management Agency
4261QM1300XMulti-Specialty Clinic/Center
5103T00000XPsychologist11075MT

General Provider Information

NPI Number : 1568782225
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERMOUNTAIN DEACONESS HOME FOR CHILDREN
Provider Business Mailing Address
First Line : 500 S LAMBORN ST
Second Line :
City : HELENA
State : MT
Zip : 59601-5417
Country : US
Telephone Number : 406-442-7920
Fax Number : 406-442-7949
Provider Business Practice Location Address
First Line : 3240 DREDGE DR
Second Line :
City : HELENA
State : MT
Zip : 59602-0548
Country : US
Telephone Number : 406-442-7920
Fax Number : 406-442-7949
Authorized Official
Title or Position : CAO
Name : JENNIFER WILLIAMS
Credential :
Telephone Number : 406-457-4822
Provider Enumeration Date : 06/04/2010
Last Update Date : 04/05/2024

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Practice Location Address:
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59602-0548
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1396809083 — CRAIG ERWIN STRUBLE LCSW
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1790066801 — MEGHAN ANN ERICKSON APRN
Practice Location Address:
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1598049777 — INTERMOUNTAIN CTS
Practice Location Address:
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1548544760 — INTERMOUNTAIN COMMUNITY CLINIC
Practice Location Address:
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59602-0548
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Practice Fax: 406-442-7949

Directions to “INTERMOUNTAIN DEACONESS HOME FOR CHILDREN ” Practice Location

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