Provider Demographics
NPI:1578599023
Name:HANGING ROCK LTC, LLC
Entity Type:Organization
Organization Name:HANGING ROCK LTC, LLC
Other - Org Name:MOUNTAIN VIEW NURSING AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-523-9094
Mailing Address - Street 1:FERNDALE APARTMENTS ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-8578
Mailing Address - Country:US
Mailing Address - Phone:606-337-7071
Mailing Address - Fax:606-337-1364
Practice Address - Street 1:39 FERNDALE APARTMENTS RD
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-8578
Practice Address - Country:US
Practice Address - Phone:606-337-7071
Practice Address - Fax:606-337-1364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100496314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12501078Medicaid
KY7100169050Medicaid
KY000000054713OtherBC/BS OF KY
KY7100169050Medicaid