Provider Demographics
NPI:1851831705
Name:MOUNTAIN HHA, LLC
Entity Type:Organization
Organization Name:MOUNTAIN HHA, LLC
Other - Org Name:MOUNTAIN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:W
Authorized Official - Last Name:RASMUSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-932-6302
Mailing Address - Street 1:1395 S MARIETTA PKWY SE
Mailing Address - Street 2:BLDG 400 SUITE 102
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4440
Mailing Address - Country:US
Mailing Address - Phone:678-932-6302
Mailing Address - Fax:678-402-5246
Practice Address - Street 1:516 BLUE RIDGE ST STE A
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-3159
Practice Address - Country:US
Practice Address - Phone:706-745-5101
Practice Address - Fax:706-745-5139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-26
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA144-132251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health