1336141779 NPI number — MOUNTAIN REGION PERSONAL CARE SERVICES INC.

Table of content: (NPI 1336141779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336141779 NPI number — MOUNTAIN REGION PERSONAL CARE SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN REGION PERSONAL CARE SERVICES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336141779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 246
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUFFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-431-1440
Provider Business Mailing Address Fax Number:
276-431-1442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
463 DUFF-PATT HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUFFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-431-1440
Provider Business Practice Location Address Fax Number:
276-431-1442
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HILL
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
276-431-1440

Provider Taxonomy Codes

  • Taxonomy code: 163WC2100X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 497592 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251E00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 009105271 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 4552980001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3747P1801X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , with the licence number: 008773106 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 385H00000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0087331060 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009105271 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0102081574 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4552980001 . This is a "NSC SUPPLIER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0087036981 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008773106 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010109043 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010039592 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008703698 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010250129 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008743576 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0102081319 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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