Provider Demographics
NPI:1043610009
Name:MONTANA INDEPENDENT LIVING PROJECT
Entity Type:Organization
Organization Name:MONTANA INDEPENDENT LIVING PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MAFFIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-442-5755
Mailing Address - Street 1:825 GREAT NORTHERN BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3340
Mailing Address - Country:US
Mailing Address - Phone:406-442-5755
Mailing Address - Fax:406-442-1612
Practice Address - Street 1:825 GREAT NORTHERN BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3340
Practice Address - Country:US
Practice Address - Phone:406-442-5755
Practice Address - Fax:406-442-1612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT170748Medicaid
MT224055Medicaid