Healthcare Provider Details

I. General information

NPI: 1114054871
Provider Name (Legal Business Name): EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 1ST AVE N
GREAT FALLS MT
59401-2507
US

IV. Provider business mailing address

PO BOX 2509
GREAT FALLS MT
59403-2509
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-3680
  • Fax: 406-761-1390
Mailing address:
  • Phone: 406-761-3680
  • Fax: 406-761-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN DORR
Title or Position: DIRECTOR OF BILLING & REIMBURSEMENT
Credential:
Phone: 406-771-3754