Provider Demographics
NPI:1942537543
Name:EASTER SEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Entity Type:Organization
Organization Name:EASTER SEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING & REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DORR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-771-3754
Mailing Address - Street 1:PO BOX 2509
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-2509
Mailing Address - Country:US
Mailing Address - Phone:406-761-3680
Mailing Address - Fax:406-761-1390
Practice Address - Street 1:991 JOE ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3163
Practice Address - Country:US
Practice Address - Phone:307-672-2816
Practice Address - Fax:307-672-3896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EASTER SEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-11-03
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management