Healthcare Provider Details

I. General information

NPI: 1033163662
Provider Name (Legal Business Name): MOUNTAIN CREEK HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 S ALBERT AVE
WALSENBURG CO
81089-2246
US

IV. Provider business mailing address

601 S ALBERT AVE
WALSENBURG CO
81089-2246
US

V. Phone/Fax

Practice location:
  • Phone: 719-738-5707
  • Fax: 719-738-1933
Mailing address:
  • Phone: 719-738-5707
  • Fax: 719-738-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS JOHNSON
Title or Position: PRESIDENT
Credential:
Phone: 423-478-5958