Provider Demographics
NPI:1396923470
Name:MOUNTAIN VALLEY CHILD AND FAMILY SERVICES, INC.
Entity type:Organization
Organization Name:MOUNTAIN VALLEY CHILD AND FAMILY SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILHOUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-265-9057
Mailing Address - Street 1:24077 HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8519
Mailing Address - Country:US
Mailing Address - Phone:530-265-9057
Mailing Address - Fax:530-292-3803
Practice Address - Street 1:24077 HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8519
Practice Address - Country:US
Practice Address - Phone:530-265-9057
Practice Address - Fax:530-292-3803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45296322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295893014OtherMEDICAL 00386
CA1689732406OtherMEDICAL 00386
CA1922185578OtherMEDICAL 00386
CA1962560771OtherMEDICAL 00386
CA1619215399OtherMEDICAL 00386