National Provider Identifier Database

STATE OF MONTANA
Intermediate Care Facility, Mentally Retarded

(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.


Contact Information

STATE OF MONTANA
310 FOURTH AVENUE
BOULDER, MT59632-0087
Phone: 406-225-4410
Fax: 406-225-4414
Website:
Specialty Taxonomy Code
* Intermediate Care Facility, Mentally Retarded 315P00000X

* Indicates primary specialty

NPI Profile & details for STATE OF MONTANA

NPI Number 1326058207
Legal business name
LBN
STATE OF MONTANA
Authorized official ALEASHA MARTIN - (FACILITY REIMBURSEMENT MANAGER)
Entity Organization
Organization subpart No
Enumeration date 08/09/2006
Last updated 12/11/2025 - About 6 months ago
Sole proprietor1 Not specified
Identifiers
  • MT License #: 10867
  • MT Medicaid: 57-0037
  • MT Medicaid: 57-0050
  • MT Medicaid: 57-0061
  • MT Medicaid: 57-0063
  • MT Medicaid: 57-0095
  • MT Medicaid: 57-0336
  • MT Medicaid: 57-2598

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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