Healthcare Provider Details

I. General information

NPI: 1215868708
Provider Name (Legal Business Name): EASTER SEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 CENTRAL AVE
GREAT FALLS MT
59405-1641
US

IV. Provider business mailing address

PO BOX 2509
GREAT FALLS MT
59403-2509
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-3754
  • Fax: 406-761-1390
Mailing address:
  • Phone: 406-771-3754
  • Fax: 406-761-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELLISSA SEVERSON-HAMPTON
Title or Position: DIRECTOR OF BILLING AND REIMBURSEME
Credential:
Phone: 406-771-3754