Provider Demographics
NPI:1457567547
Name:MOUNTAINSHADOW CHALLENGE, L.L.C
Entity Type:Organization
Organization Name:MOUNTAINSHADOW CHALLENGE, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALMUT
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:775-355-1972
Mailing Address - Street 1:2372 WABASH CIR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-8840
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2372 WABASH CIR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-8840
Practice Address - Country:US
Practice Address - Phone:775-762-3548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)