Provider Demographics
NPI:1326639733
Name:MOUNTAIN VIEW HOME CARE, LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GALENA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-551-3570
Mailing Address - Street 1:PO BOX 769
Mailing Address - Street 2:
Mailing Address - City:CHINLE
Mailing Address - State:AZ
Mailing Address - Zip Code:86503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:COUNTY RD 444, 1.5 MI NE
Practice Address - Street 2:
Practice Address - City:TSAILE
Practice Address - State:AZ
Practice Address - Zip Code:86556
Practice Address - Country:US
Practice Address - Phone:928-724-3522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty