Provider Demographics
NPI:1740604735
Name:MOUNTAINEER CASE MANAGEMENT LLC
Entity Type:Organization
Organization Name:MOUNTAINEER CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:ELBON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:304-591-4544
Mailing Address - Street 1:1859B BEVERLY PIKE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241
Mailing Address - Country:US
Mailing Address - Phone:304-591-4544
Mailing Address - Fax:304-591-4560
Practice Address - Street 1:1859 BEVERLY PIKE
Practice Address - Street 2:SUITE B
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241
Practice Address - Country:US
Practice Address - Phone:304-591-4544
Practice Address - Fax:304-591-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVUD000305954001302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization