Healthcare Provider Details

I. General information

NPI: 1356351183
Provider Name (Legal Business Name): STATE OF MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VETERANS DRIVE
COLUMBIA FALLS MT
59912-0250
US

IV. Provider business mailing address

111 N SANDERS ST DEPT 30
HELENA MT
59601-4520
US

V. Phone/Fax

Practice location:
  • Phone: 406-892-3256
  • Fax: 406-892-0256
Mailing address:
  • Phone: 406-444-3416
  • Fax: 406-444-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10640
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALEASHA MARTIN
Title or Position: FACILITY REIMBURSEMENT MANAGER
Credential:
Phone: 406-444-3416