Provider Demographics
NPI:1811056898
Name:MONTANA CHILDREN'S HOME & HOSPITAL
Entity type:Organization
Organization Name:MONTANA CHILDREN'S HOME & HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:RCM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:AFANADOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-444-1066
Mailing Address - Street 1:2755 COLONIAL DR
Mailing Address - Street 2:P.O. BOX 5539
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-5539
Mailing Address - Country:US
Mailing Address - Phone:406-444-7500
Mailing Address - Fax:406-444-7588
Practice Address - Street 1:2755 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-444-7500
Practice Address - Fax:406-444-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 251B00000X, 101YM0800X, 101YP2500X, 282N00000X
MT11031283Q00000X, 291U00000X, 283Q00000X
MT3801007320800000X
MT11030323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric HospitalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical Laboratory
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT410098Medicaid
MT4106427Medicaid
MT410098Medicaid