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Contact Information

STATE OF MONTANA
310 FOURTH AVENUE
BOULDER, MT59632-0087
 Phone: 406-225-4410
 Fax: 406-225-4414
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Intermediate Care Facility, Mentally Retarded

315P00000X
Indicates primary specialty

NPI Profile & details for STATE OF MONTANA

NPI # 1326058207
LBN Legal business name STATE OF MONTANA
Authorized official ALEASHA MARTIN - (FACILITY REIMBURSEMENT MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/09/2006
Last updated 12/11/2025 - About 6 months ago
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 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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