Healthcare Provider Details

I. General information

NPI: 1669758785
Provider Name (Legal Business Name): INTERMOUNTAIN AFS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3240 DREDGE DR
HELENA MT
59602-0548
US

IV. Provider business mailing address

3240 DREDGE DR
HELENA MT
59602-0548
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 TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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