Provider Demographics
NPI:1033805015
Name:MOUNTAIN HIGH RECOVERY CENTER
Entity Type:Organization
Organization Name:MOUNTAIN HIGH RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-207-9519
Mailing Address - Street 1:2949 LAKE TAHOE BLVD
Mailing Address - Street 2:SUITE B7
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150
Mailing Address - Country:US
Mailing Address - Phone:530-600-6505
Mailing Address - Fax:
Practice Address - Street 1:2949 LAKE TAHOE BLVD
Practice Address - Street 2:SUITE B7
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150
Practice Address - Country:US
Practice Address - Phone:530-600-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty