Provider Demographics
NPI:1780038422
Name:MOUNTAIN RIDGE COMMUNITY CARE INC
Entity Type:Organization
Organization Name:MOUNTAIN RIDGE COMMUNITY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISMAIL
Authorized Official - Middle Name:HAKKI
Authorized Official - Last Name:CAMUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-435-2222
Mailing Address - Street 1:420 BAKER AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-1871
Mailing Address - Country:US
Mailing Address - Phone:606-435-2222
Mailing Address - Fax:606-435-2226
Practice Address - Street 1:420 BAKER AVE APT 103
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-1871
Practice Address - Country:US
Practice Address - Phone:606-435-2222
Practice Address - Fax:606-435-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251B00000X
251C00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health