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State Of Montana
Intellectual Disabilities Intermediate Care Facility in Boulder, Montana
NPI 1326058207

State Of Montana is a Intellectual Disabilities Intermediate Care Facility based in Helena, MT. State Of Montana practices in Boulder, MT. The NPI Number for State Of Montana is 1326058207 and holds a License No. 10867 (Montana).

The current practice location address for State Of Montana is 310 Fourth Avenue, Boulder, MT and can be reached out via phone at 406-225-4410 and via fax at 406-225-4414.

Location: 310 Fourth Avenue, Boulder, MT, 59601-4520
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1326058207
Provider Name
State Of Montana
Credential
Provider Entity Type
Organization
Address
310 Fourth Avenue, Boulder, MT, 59601-4520
Phone Number
406-225-4410
Fax Number
406-225-4414
Provider Enumeration Date
08/09/2006
Last Update Date
03/08/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
57-0037 05 MT
57-0063 05 MT
57-0336 05 MT
57-2598 05 MT
57-0095 05 MT
57-0061 05 MT
57-0050 05 MT
institution
Provider Business Practice Location Address Details
Address
310 Fourth Avenue
City
Boulder
State
Montana
Zip
59632-0087
Phone Number
406-225-4410
Fax Number
406-225-4414
person
Provider Business Mailing Address Details
Address
310 Fourth Avenue
City
Boulder
State
Montana
Zip
59632-0087
Phone Number
406-225-4410
Fax Number
406-225-4414
person
Provider's Taxonomy Details 1
Type
Nursing & Custodial Care Facilities
Classification
Intermediate Care Facility, Mentally Retarded
Speciality
-
Taxonomy
315P00000X
License No.
10867 (Montana)
Definition
(1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals.
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