Organization
EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK SHERMAN (CFO)
(406) 771-3762
Entity
Organization
Contact information
Practice address
1408 W HAYS ST, BOISE, ID 83702-5028
(208) 345-2208
Mailing address
425 1ST AVE N, GREAT FALLS, MT 59401-2507
(406) 761-3680
(406) 761-1390
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
80761200
—
ID
Enumeration date
03/21/2007
Last updated
03/26/2019
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