1396754875 NPI number — MOUNTAIN VISTA HEALTH PARK, INC.

Table of content: (NPI 1396754875)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396754875 NPI number — MOUNTAIN VISTA HEALTH PARK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN VISTA HEALTH PARK, 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:
6
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:
1396754875
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1547
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27239-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-859-2181
Provider Business Mailing Address Fax Number:
336-859-4053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 MT VISTA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27239-8793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-859-2181
Provider Business Practice Location Address Fax Number:
336-859-4053
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCDONALD
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
B
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
336-859-2181

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3405196 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3406191 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com