Healthcare Provider Details

I. General information

NPI: 1528079720
Provider Name (Legal Business Name): STATE OF MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CASINO CREEK DR
LEWISTOWN MT
59457-3359
US

IV. Provider business mailing address

111 N SANDERS ST DEPT 30
HELENA MT
59601-4520
US

V. Phone/Fax

Practice location:
  • Phone: 406-538-7451
  • Fax: 406-538-2863
Mailing address:
  • Phone: 406-444-3416
  • Fax: 406-444-3082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310500000X
TaxonomyMental Illness Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. ALEASHA MARTIN
Title or Position: FACILITY REIMBURSEMENT MANAGER
Credential:
Phone: 406-444-3416