Organization
EASTER SEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN DORR (DIRECTOR OF BILLING & REIMBURSEMENT)
(406) 771-3754
Entity
Organization
Contact information
Practice address
1465 S VINNELL WAY, BOISE, ID 83709-1659
(208) 378-9924
(208) 378-9965
Mailing address
425 1ST AVE N, GREAT FALLS, MT 59401-2507
(406) 761-3680
(406) 761-1390
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806565700
—
ID
Enumeration date
03/22/2007
Last updated
02/05/2018
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