Healthcare Provider Details

I. General information

NPI: 1538211453
Provider Name (Legal Business Name): MOUNTAIN OUTREACH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3198 HIGHWAY 343
MC ROBERTS KY
41835-9047
US

IV. Provider business mailing address

PO BOX 271
NEON KY
41840-0271
US

V. Phone/Fax

Practice location:
  • Phone: 606-832-9026
  • Fax: 606-832-9061
Mailing address:
  • Phone: 606-832-9026
  • Fax: 606-832-9061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number750082
License Number StateKY

VIII. Authorized Official

Name: VERNON HALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 60068329026