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Organization
STATE OF MONTANA
Active
Organization
STATE OF MONTANA
Active
Other names
Montana Developmental Center, Intensive Behavior Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALEASHA MARTIN (FACILITY REIMBURSEMENT MANAGER)
(406) 444-3416
Entity
Organization
Contact information
Practice address
310 FOURTH AVENUE, BOULDER, MT 59632-0087
(406) 225-4410
(406) 225-4414
Mailing address
111 N SANDERS ST DEPT 30, HELENA, MT 59601-4520
(406) 444-3416
(406) 444-3082
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
10867
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57-0037
—
MT
05
—
57-0050
—
MT
05
—
57-0061
—
MT
05
—
57-0063
—
MT
05
—
57-0095
—
MT
05
—
57-0336
—
MT
05
—
57-2598
—
MT
Enumeration date
08/09/2006
Last updated
12/11/2025
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