Healthcare Provider Details

I. General information

NPI: 1326639733
Provider Name (Legal Business Name): MOUNTAIN VIEW HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 02/19/2021
Certification Date: 02/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COUNTY RD 444, 1.5 MI NE
TSAILE AZ
86556
US

IV. Provider business mailing address

PO BOX 769
CHINLE AZ
86503
US

V. Phone/Fax

Practice location:
  • Phone: 928-724-3522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: GALENA MAE DAVIS
Title or Position: OWNER
Credential:
Phone: 928-551-3570