Provider Demographics
NPI:1326345364
Name:MOUNTAINEER HOME CARE SERVICES LLC
Entity Type:Organization
Organization Name:MOUNTAINEER HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:ELBON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-704-6475
Mailing Address - Street 1:301 CENTRAL ST APT 3
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3199
Mailing Address - Country:US
Mailing Address - Phone:304-636-5252
Mailing Address - Fax:304-591-4521
Practice Address - Street 1:301 CENTRAL ST APT 3
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3199
Practice Address - Country:US
Practice Address - Phone:304-636-5252
Practice Address - Fax:304-591-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2247-8825253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care