Provider Demographics
NPI:1629247812
Name:EAGLE MOUNT - BOZEMAN
Entity Type:Organization
Organization Name:EAGLE MOUNT - BOZEMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGREGOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-586-1781
Mailing Address - Street 1:6901 GOLDENSTEIN LN
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8005
Mailing Address - Country:US
Mailing Address - Phone:406-586-1781
Mailing Address - Fax:406-586-5794
Practice Address - Street 1:6901 GOLDENSTEIN LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8005
Practice Address - Country:US
Practice Address - Phone:406-586-1781
Practice Address - Fax:406-586-5794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services