Healthcare Provider Details

I. General information

NPI: 1730507609
Provider Name (Legal Business Name): INTERMOUNTAIN SERVICIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number303
License Number StateMT

VIII. Authorized Official

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