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General NPI Number Information
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NPI Number | 1508716390
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Entity Type | Organization
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Legal Business Name | EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
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Dates
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Enumeration Date | 01/30/2026
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Last Update Date | 01/30/2026
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Provider Practice Location Address
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Address Line | 1733 MT HIGHWAY 35
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City | KALISPELL
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State | MT
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Zip | 59901-2464
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Country | US
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Telephone | 406-609-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 425 1ST AVE N
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City | GREAT FALLS
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State | MT
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Zip | 59401-2507
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARK PATRICK SHERMAN
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Credential |
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Telephone | 406-771-3762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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