Provider Demographics
NPI:1164697991
Name:EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC
Entity Type:Organization
Organization Name:EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC
Other - Org Name:EASTER SEALS-GOODWILLL PEDIATRIC THERAPY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-771-3762
Mailing Address - Street 1:425 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2507
Mailing Address - Country:US
Mailing Address - Phone:406-761-3680
Mailing Address - Fax:406-761-1390
Practice Address - Street 1:1537 AVENUE D
Practice Address - Street 2:SUITE 210
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-3048
Practice Address - Country:US
Practice Address - Phone:406-252-9600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty