Provider Demographics
NPI:1881743847
Name:GREAT DIVIDE EDUCATION SERVICES
Entity type:Organization
Organization Name:GREAT DIVIDE EDUCATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-846-2147
Mailing Address - Street 1:511 MAIN ST
Mailing Address - Street 2:P.O. BOX 48
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-1414
Mailing Address - Country:US
Mailing Address - Phone:406-846-2147
Mailing Address - Fax:406-846-2154
Practice Address - Street 1:511 MAIN ST
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1414
Practice Address - Country:US
Practice Address - Phone:406-846-2147
Practice Address - Fax:406-846-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0163397Medicaid
MT161902Medicaid
MT0165113Medicaid
MT0165451Medicaid
MT161811Medicaid
MT162084Medicaid
MT162110Medicaid