Provider Demographics
NPI:1073058673
Name:MOUNTAIN VIEW RESIDENTIAL INC.
Entity Type:Organization
Organization Name:MOUNTAIN VIEW RESIDENTIAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:MASHELL
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:540-297-4039
Mailing Address - Street 1:1143 GOLF VIEW CT
Mailing Address - Street 2:
Mailing Address - City:HUDDLESTON
Mailing Address - State:VA
Mailing Address - Zip Code:24104-4303
Mailing Address - Country:US
Mailing Address - Phone:540-297-4039
Mailing Address - Fax:
Practice Address - Street 1:1143 GOLF VIEW CT
Practice Address - Street 2:
Practice Address - City:HUDDLESTON
Practice Address - State:VA
Practice Address - Zip Code:24104-4303
Practice Address - Country:US
Practice Address - Phone:540-297-4039
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA250801001320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities