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NPI Code Detail

MEDICARE: EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.

MEDICARE: EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1253Z00000XIn Home Supportive Care Agency
2251S00000XCommunity/Behavioral Health Agency
3251J00000XNursing Care AgencyMT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114054871
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Provider Business Mailing Address
First Line : PO BOX 2509
Second Line :
City : GREAT FALLS
State : MT
Zip : 59403-2509
Country : US
Telephone Number : 406-761-3680
Fax Number : 406-761-1390
Provider Business Practice Location Address
First Line : 425 1ST AVE N
Second Line :
City : GREAT FALLS
State : MT
Zip : 59401-2507
Country : US
Telephone Number : 406-771-3680
Fax Number : 406-761-1390
Authorized Official
Title or Position : DIRECTOR OF BILLING & REIMBURSEMENT
Name : SUSAN DORR
Credential :
Telephone Number : 406-771-3754
Provider Enumeration Date : 02/28/2007
Last Update Date : 12/08/2025

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