Healthcare Provider Details

I. General information

NPI: 1376661926
Provider Name (Legal Business Name): EASTERN MONTANA INDUSTRIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S HAYNES AVE
MILES CITY MT
59301-5723
US

IV. Provider business mailing address

805 S HAYNES AVE
MILES CITY MT
59301-5723
US

V. Phone/Fax

Practice location:
  • Phone: 406-234-3740
  • Fax: 406-234-3742
Mailing address:
  • Phone: 406-234-3740
  • Fax: 406-234-3742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON K BRENCE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-234-3740