Provider Demographics
NPI:1336141779
Name:MOUNTAIN REGION PERSONAL CARE SERVICES INC.
Entity Type:Organization
Organization Name:MOUNTAIN REGION PERSONAL CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-431-1440
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:DUFFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24244
Mailing Address - Country:US
Mailing Address - Phone:276-431-1440
Mailing Address - Fax:276-431-1442
Practice Address - Street 1:463 DUFF-PATT HWY
Practice Address - Street 2:
Practice Address - City:DUFFIELD
Practice Address - State:VA
Practice Address - Zip Code:24244
Practice Address - Country:US
Practice Address - Phone:276-431-1440
Practice Address - Fax:276-431-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA163WC2100X, 251E00000X, 3747P1801X, 385H00000X
VA497592251E00000X
VA009105271332B00000X
VA4552980001332B00000X
VA008773106385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0087331060Medicaid
VA009105271Medicaid
VA0102081574Medicaid
4552980001OtherNSC SUPPLIER #
VA0087036981Medicaid
VA008773106Medicaid
VA010109043Medicaid
VA010039592Medicaid
VA008703698Medicaid
VA010250129Medicaid
VA008743576Medicaid
VA0102081319Medicaid
VA008743576Medicaid
VA008703698Medicaid