Provider Demographics
NPI:1972593002
Name:HAYESVILLE FAMILY CARE LLC
Entity Type:Organization
Organization Name:HAYESVILLE FAMILY CARE LLC
Other - Org Name:MOUNTAIN VIEW FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER MANAGER PROVIDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:828-389-1617
Mailing Address - Street 1:2076 HIGHWAY 69
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904
Mailing Address - Country:US
Mailing Address - Phone:828-389-1617
Mailing Address - Fax:828-389-1640
Practice Address - Street 1:2076 HIGHWAY 69
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904
Practice Address - Country:US
Practice Address - Phone:828-389-1617
Practice Address - Fax:828-389-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health