Provider Demographics
NPI:1407275639
Name:MOUNTAIN TOP ALF LLC
Entity Type:Organization
Organization Name:MOUNTAIN TOP ALF LLC
Other - Org Name:STONE COUNTY RESIDENTIAL CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-869-5116
Mailing Address - Street 1:414 MASSEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-6132
Mailing Address - Country:US
Mailing Address - Phone:870-269-5845
Mailing Address - Fax:870-269-2172
Practice Address - Street 1:414 MASSEY AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-6132
Practice Address - Country:US
Practice Address - Phone:870-269-5845
Practice Address - Fax:870-269-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR493310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility