MEDICARE: MOUNTAIN HOME MONTANA 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
1	251S00000X	Community/Behavioral Health Agency	709LCSW	MT
2	251B00000X	Case Management Agency	13491	MT
3	261Q00000X	Clinic/Center
4	251S00000X	Community/Behavioral Health Agency	13491	MT
5	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
6	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1265752034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN HOME MONTANA INC

Provider Business Mailing Address
First Line	:	4720 23RD AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1137
Country	:	US
Telephone Number	:	406-541-4663
Fax Number	:	406-541-4662

Provider Business Practice Location Address
First Line	:	4720 23RD AVE
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-1137
Country	:	US
Telephone Number	:	406-541-4663
Fax Number	:	406-541-4662

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	GRETA JERNBERG
Credential	:	LCSW
Telephone Number	:	406-541-4663

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	01/13/2026

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