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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
1251E00000XHome Health Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1217990OTHERMTBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437159035
Entity Type Code : Organization
Provider Name (Legal Business Name) : EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC
Provider Business Mailing 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
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 : 406-454-3883
Fax Number : 406-454-3235
Authorized Official
Title or Position : CFO
Name : MARK SHERMAN
Credential :
Telephone Number : 406-771-3762
Provider Enumeration Date : 07/26/2005
Last Update Date : 03/26/2019

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