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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
2171W00000XContractor
3251S00000XCommunity/Behavioral Health AgencyID

General Provider Information

NPI Number : 1558706945
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 : 406-771-3754
Fax Number :
Provider Business Practice Location Address
First Line : 524 S 9TH AVE STE 103
Second Line :
City : CALDWELL
State : ID
Zip : 83605-5072
Country : US
Telephone Number : 208-454-8555
Fax Number : 208-454-8828
Authorized Official
Title or Position : CFO
Name : MARK SHERMAN
Credential :
Telephone Number : 406-771-3762
Provider Enumeration Date : 04/30/2013
Last Update Date : 03/20/2026

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