MEDICARE: MOUNTAIN CARE LLC

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	315P00000X	Intellectual Disabilities Intermediate Care Facility
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1952185779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN CARE LLC

Provider Business Mailing Address
First Line	:	2300 W SAHARA AVE STE 800
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-4397
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 H ST APT C
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-2544
Country	:	US
Telephone Number	:	725-251-3362
Fax Number	:	702-549-1915

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	ABDUL COOPER
Credential	:
Telephone Number	:	510-393-5306

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	04/17/2025

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Directions to “MOUNTAIN CARE LLC ” Practice Location

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