Healthcare Provider Details

I. General information

NPI: 1972205284
Provider Name (Legal Business Name): MONTANA CHILDREN'S HOME & HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 SHODAIR DRIVE
HELENA MT
59601
US

IV. Provider business mailing address

PO BOX 5539
HELENA MT
59604-5539
US

V. Phone/Fax

Practice location:
  • Phone: 406-444-1125
  • Fax: 406-884-2085
Mailing address:
  • Phone: 406-444-7500
  • Fax: 406-884-2085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NELSON AFANADOR
Title or Position: DIRECTOR OF BUSINESS OPERATIONS
Credential:
Phone: 406-444-1066