Provider Demographics
NPI:1811539190
Name:ROOTS REHAB
Entity Type:Organization
Organization Name:ROOTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE & BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-459-8163
Mailing Address - Street 1:PO BOX 5175
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-5175
Mailing Address - Country:US
Mailing Address - Phone:406-439-6937
Mailing Address - Fax:406-422-0359
Practice Address - Street 1:104 W CUSTER AVE STE 7
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0106
Practice Address - Country:US
Practice Address - Phone:406-439-6937
Practice Address - Fax:406-422-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000537329Medicaid