Provider Demographics
NPI:1982601076
Name:MOUNTAIN HOME NURSING SERVICE, INC.
Entity Type:Organization
Organization Name:MOUNTAIN HOME NURSING SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:H
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-389-8106
Mailing Address - Street 1:PO BOX 1306
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-1306
Mailing Address - Country:US
Mailing Address - Phone:828-389-8106
Mailing Address - Fax:828-389-8484
Practice Address - Street 1:115 MOUNTAIN HOME NURSING LN
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-5811
Practice Address - Country:US
Practice Address - Phone:828-389-8106
Practice Address - Fax:828-389-8484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC0104251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6600014Medicaid
NC3408645Medicaid
NC3407033Medicaid
NC3407033Medicaid