Provider Demographics
NPI:1669435715
Name:MOUNTAIN HOME CARE EQUIPMENT, INC.
Entity type:Organization
Organization Name:MOUNTAIN HOME CARE EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:CRRT/RRT
Authorized Official - Phone:706-635-4494
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-0009
Mailing Address - Country:US
Mailing Address - Phone:706-635-4494
Mailing Address - Fax:
Practice Address - Street 1:200 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 113
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3722
Practice Address - Country:US
Practice Address - Phone:706-635-4494
Practice Address - Fax:706-635-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
GA332BX2000X332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00319503AMedicaid
GA00649129AMedicaid
GA00319503AMedicaid