Healthcare Provider Details

I. General information

NPI: 1265609796
Provider Name (Legal Business Name): MOUNTAIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 VALLEY STREET SUITE A
CUMBERLAND MD
21502
US

IV. Provider business mailing address

117 VALLEY STREET SUITE A
CUMBERLAND MD
21502
US

V. Phone/Fax

Practice location:
  • Phone: 240-362-7074
  • Fax:
Mailing address:
  • Phone: 240-362-7074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. WALTER JOHN MCMULLEN
Title or Position: OWNER
Credential:
Phone: 240-362-7074