Healthcare Provider Details

I. General information

NPI: 1568782225
Provider Name (Legal Business Name): INTERMOUNTAIN DEACONESS HOME FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 DREDGE DR
HELENA MT
59602-0548
US

IV. Provider business mailing address

500 S LAMBORN ST
HELENA MT
59601-5417
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-7920
  • Fax: 406-442-7949
Mailing address:
  • Phone: 406-442-7920
  • Fax: 406-442-7949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number11075
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number11075
License Number StateMT
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11075
License Number StateMT

VIII. Authorized Official

Name: JENNIFER WILLIAMS
Title or Position: CAO
Credential:
Phone: 406-457-4822