Provider Demographics
NPI:1053577205
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:RCM DIRECTOR
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:406-444-7500
Practice Address - Fax:406-884-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT410098Medicaid