NPIMap

Organization Active NPI

Easter Seals-Goodwill Northern Rocky Mountain, Inc.

  • Case Management Agency
  • Boise, ID
National Provider Identifier
1679699540
Registry record updated Feb 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
EASTER SEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.
Practice address
1465 S Vinnell Way
Boise, ID 83709-1659
Phone
(208) 378-9924
Fax
(208) 378-9965
NPI assigned
Mar 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Dorr
Title
Director of Billing & Reimbursement
Phone
(406) 771-3754

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

1465 S Vinnell Way
Boise, ID 83709-1659

Mailing address

425 1St Ave N
Great Falls, MT 59401-2507
Phone (406) 761-3680

Other identifiers 1

IdentifierTypeStateIssuer
806565700MedicaidID

National Provider Directory

National Provider Directory
Tax ID family
Montana Easter Seal Soc25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1517788800000",
    "number": "1679699540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 1ST AVE N",
            "city": "GREAT FALLS",
            "state": "MT",
            "postal_code": "594012507",
            "telephone_number": "406-761-3680",
            "fax_number": "406-761-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 S VINNELL WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837091659",
            "telephone_number": "208-378-9924",
            "fax_number": "208-378-9965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTER SEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2018-02-05",
        "status": "A",
        "authorized_official_last_name": "DORR",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING & REIMBURSEMENT",
        "authorized_official_telephone_number": "406-771-3754"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806565700",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.