Provider Demographics
NPI:1922684588
Name:MOUNTAIN VIEW TRANSITIONAL LLC
Entity Type:Organization
Organization Name:MOUNTAIN VIEW TRANSITIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MASTER OF SCIENCE
Authorized Official - Phone:213-709-5096
Mailing Address - Street 1:3623 SHANDIN DR
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-5837
Mailing Address - Country:US
Mailing Address - Phone:213-709-5096
Mailing Address - Fax:
Practice Address - Street 1:3623 SHANDIN DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-5837
Practice Address - Country:US
Practice Address - Phone:213-709-5096
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
No251S00000XAgenciesCommunity/Behavioral Health