Healthcare Provider Details

I. General information

NPI: 1881743847
Provider Name (Legal Business Name): GREAT DIVIDE EDUCATION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 MAIN ST
DEER LODGE MT
59722-1414
US

IV. Provider business mailing address

511 MAIN ST P.O. BOX 48
DEER LODGE MT
59722-1414
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-2147
  • Fax: 406-846-2154
Mailing address:
  • Phone: 406-846-2147
  • Fax: 406-846-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. JIM MCDONALD
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential:
Phone: 406-846-2147