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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
1251G00000XCommunity Based Hospice Care AgencyMT

General Provider Information

NPI Number : 1386144798
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 : 406-761-3680
Fax Number : 406-761-1390
Authorized Official
Title or Position : CFO
Name : MARK SHERMAN
Credential :
Telephone Number : 406-771-3762
Provider Enumeration Date : 02/13/2018
Last Update Date : 03/26/2019

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