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
1607 N PARKCENTRE PL, NAMPA, ID 83651-1705
(208) 461-8470
Mailing address
PO BOX 2509, GREAT FALLS, MT 59403-2509
(406) 761-3680
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Q7380
PSYCHOTHERAPY
ID
01
—
Q7381
PSYCHOTHERAPY
ID
01
—
Q7385
PSYCHOTHERAPY
ID
Enumeration date
05/22/2007
Last updated
03/26/2019
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