Provider Demographics
NPI:1245997238
Name:MOUNTAIN VIEW COMMUNITY MENTAL HEALTH AND RECOVERY CENTER LLC
Entity type:Organization
Organization Name:MOUNTAIN VIEW COMMUNITY MENTAL HEALTH AND RECOVERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:DELPHINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ATU-TETUH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, PMHNP-BC
Authorized Official - Phone:907-229-2621
Mailing Address - Street 1:3523 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1111
Mailing Address - Country:US
Mailing Address - Phone:907-229-2621
Mailing Address - Fax:
Practice Address - Street 1:3950 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1511
Practice Address - Country:US
Practice Address - Phone:907-229-2621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-24
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1712190Medicaid