Healthcare Provider Details

I. General information

NPI: 1982989604
Provider Name (Legal Business Name): MOUNTAIN HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 HENDERSONVILLE RD SUITE #3
ARDEN NC
28704-2753
US

IV. Provider business mailing address

PO BOX 517
ARDEN NC
28704-0517
US

V. Phone/Fax

Practice location:
  • Phone: 828-684-6444
  • Fax: 828-684-6499
Mailing address:
  • Phone: 828-684-6444
  • Fax: 828-684-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberHC3777
License Number StateNC

VIII. Authorized Official

Name: MRS. ARLANA AULL WILDE
Title or Position: OWNER
Credential: CSA
Phone: 828-684-6444