Provider Demographics
NPI:1235910159
Name:MOUNTAINVIEW SERVICES, LLC
Entity Type:Organization
Organization Name:MOUNTAINVIEW SERVICES, LLC
Other - Org Name:ELLIE MENTAL HEALTH-WEST VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:PALKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-554-7759
Mailing Address - Street 1:1774 JEFFERSON RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:PA
Mailing Address - Zip Code:15344-4157
Mailing Address - Country:US
Mailing Address - Phone:724-554-7759
Mailing Address - Fax:
Practice Address - Street 1:1206 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1828
Practice Address - Country:US
Practice Address - Phone:724-554-7759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-06
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty