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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