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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
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1558593830
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 : 5242 SOUTH 4820 WEST
Second Line : ATT JANET WADE
City : KEARNS
State : UT
Zip : 84118
Country : US
Telephone Number : 801-633-2091
Fax Number :
Authorized Official
Title or Position : CFO
Name : MARK SHERMAN
Credential :
Telephone Number : 406-771-3762
Provider Enumeration Date : 08/20/2009
Last Update Date : 03/26/2019

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Directions to “EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC. ” Practice Location

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