MEDICARE: MOUNTAIN HOME HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251G00000X	Community Based Hospice Care Agency	6479	NM
2	251E00000X	Home Health Agency	6058A1	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215932587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN HOME HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2566
Second Line	:
City	:	TAOS
State	:	NM
Zip	:	87571-2566
Country	:	US
Telephone Number	:	575-758-4786
Fax Number	:	575-758-0560

Provider Business Practice Location Address
First Line	:	630 PASEO DEL PUEBLO SUR
Second Line	:	# 180
City	:	TAOS
State	:	NM
Zip	:	87571-7023
Country	:	US
Telephone Number	:	505-758-1024
Fax Number	:	505-758-0560

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	BETTE MYERSON
Credential	:
Telephone Number	:	575-758-4786

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	04/09/2009

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Directions to “MOUNTAIN HOME HEALTH CARE, INC. ” Practice Location

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