Provider Demographics
NPI:1851437701
Name:MOUNTAIN CIRCLE FAMILY SERVICE, INC.
Entity Type:Organization
Organization Name:MOUNTAIN CIRCLE FAMILY SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:O'BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-284-7007
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947-0554
Mailing Address - Country:US
Mailing Address - Phone:530-284-7007
Mailing Address - Fax:530-284-7111
Practice Address - Street 1:4600 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5033
Practice Address - Country:US
Practice Address - Phone:775-825-9995
Practice Address - Fax:775-825-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare