Provider Demographics
NPI:1982989604
Name:MOUNTAIN HOME CARE LLC
Entity Type:Organization
Organization Name:MOUNTAIN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ARLANA
Authorized Official - Middle Name:AULL
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:828-684-6444
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-0517
Mailing Address - Country:US
Mailing Address - Phone:828-684-6444
Mailing Address - Fax:828-684-6499
Practice Address - Street 1:2270 HENDERSONVILLE RD
Practice Address - Street 2:SUITE #3
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-2753
Practice Address - Country:US
Practice Address - Phone:828-684-6444
Practice Address - Fax:828-684-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3777253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care