Provider Demographics
NPI:1760727978
Name:MOUNTAIN VALLEY TREATMENT CENTER
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY TREATMENT CENTER
Other - Org Name:MOUNTAIN VALLEY TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:EVERETT
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BC
Authorized Official - Phone:603-989-3500
Mailing Address - Street 1:703 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03781
Mailing Address - Country:US
Mailing Address - Phone:603-989-3500
Mailing Address - Fax:603-297-1816
Practice Address - Street 1:703 RIVER ROAD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NH
Practice Address - Zip Code:03781
Practice Address - Country:US
Practice Address - Phone:603-989-3500
Practice Address - Fax:603-297-1816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHCCRB-06502320800000X
320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness