Provider Demographics
NPI:1467753103
Name:MOUNTAIN WINGS; LLC
Entity Type:Organization
Organization Name:MOUNTAIN WINGS; LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-207-0241
Mailing Address - Street 1:321 OLD GRAY STATION RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3533
Mailing Address - Country:US
Mailing Address - Phone:423-207-0241
Mailing Address - Fax:
Practice Address - Street 1:321 OLD GRAY STATION RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-3533
Practice Address - Country:US
Practice Address - Phone:423-207-0241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care