Provider Demographics
NPI:1952433112
Name:MOUNTAIN HORIZON OF HOPE,INC.
Entity Type:Organization
Organization Name:MOUNTAIN HORIZON OF HOPE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPANY TROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-487-1863
Mailing Address - Street 1:1979 N KY HWY 15 SOUTH SUITE# 3
Mailing Address - Street 2:PO BOX 761 HAZARD
Mailing Address - City:KENTUCKY
Mailing Address - State:KY
Mailing Address - Zip Code:41702
Mailing Address - Country:US
Mailing Address - Phone:606-487-1860
Mailing Address - Fax:606-487-0119
Practice Address - Street 1:1979 N KY HIGHWAY 15 STE 3
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-5620
Practice Address - Country:US
Practice Address - Phone:606-487-1860
Practice Address - Fax:606-487-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Single Specialty
Not Answered251B00000XAgenciesCase Management
Not Answered251C00000XAgenciesDay Training, Developmentally Disabled Services
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered251X00000XAgenciesSupports Brokerage
Not Answered3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Not Answered385H00000XRespite Care FacilityRespite CareGroup - Single Specialty
Not Answered385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY33000670Medicaid