- Enrollment id
- O20100615000324
- Enrollment state
- MT
- Provider type code
- 00-06
- Provider type text
- PART A PROVIDER - HOME HEALTH AGENCY
- Npi
- 1437159035
- Multiple npi flag
- N
- Ccn
- 277087
- Associate id
- 4789608704
- Organization name
- EASTERSEALS-GOODWILL NORTHERN ROCKY MOUNTAIN, INC
- Doing business as name
- MEDALLION HOME CARE
- Incorporation date
- 1947-08-29
- Incorporation state
- MT
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 425 1ST AVE N
- City
- GREAT FALLS
- State
- MT
- Zip code
- 594012507