Provider Demographics
| NPI: | 1972205284 |
|---|---|
| Name: | MONTANA CHILDREN'S HOME & HOSPITAL |
| Entity type: | Organization |
| Organization Name: | MONTANA CHILDREN'S HOME & HOSPITAL |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR OF BUSINESS OPERATIONS |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | NELSON |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | AFANADOR |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 406-444-1066 |
| Mailing Address - Street 1: | PO BOX 5539 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HELENA |
| Mailing Address - State: | MT |
| Mailing Address - Zip Code: | 59604-5539 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 406-444-7500 |
| Mailing Address - Fax: | 406-884-2085 |
| Practice Address - Street 1: | 2620 SHODAIR DRIVE |
| Practice Address - Street 2: | |
| Practice Address - City: | HELENA |
| Practice Address - State: | MT |
| Practice Address - Zip Code: | 59601 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 406-444-1125 |
| Practice Address - Fax: | 406-884-2085 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2023-03-20 |
| Last Update Date: | 2024-01-12 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QG0250X | Ambulatory Health Care Facilities | Clinic/Center | Genetics | Group - Multi-Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| Yes | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 170300000X | Other Service Providers | Genetic Counselor, MS | Group - Multi-Specialty | |
| No | 207SG0201X | Allopathic & Osteopathic Physicians | Medical Genetics | Clinical Genetics (M.D.) | Group - Multi-Specialty |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
