Organization
EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC
Active
Parent organization
EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Other names
Medallion Home Care, Medallion Medical Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Authorized official
MARK SHERMAN (CFO)
(406) 771-3762
Entity
Organization
Contact information
Practice address
425 1ST AVE N, GREAT FALLS, MT 59401-2507
(406) 454-3883
(406) 454-3235
Mailing address
425 1ST AVE N, GREAT FALLS, MT 59401-2507
(406) 761-3680
(406) 761-1390
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
217990
BCBS
MT
05
—
740044
—
MT
Enumeration date
07/26/2005
Last updated
03/26/2019
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