MEDICARE: MOUNTAINS COMMINITY HOSPITAL

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	282NR1301X	Rural Acute Care Hospital	AT 3444	CA

General Provider Information

NPI Number	:	1326314048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINS COMMINITY HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 70
Second Line	:
City	:	LAKE ARROWHEAD
State	:	CA
Zip	:	92352-0070
Country	:	US
Telephone Number	:	909-336-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	29101 HOSPITAL RD
Second Line	:	SUITE 106
City	:	LAKE ARROWHEAD
State	:	CA
Zip	:	92352-0070
Country	:	US
Telephone Number	:	909-336-3651
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST ASSISTANT
Name	:	MRS. MICHELLE GERTRUDE KELLY
Credential	:
Telephone Number	:	909-336-3651

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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