Healthcare Provider Details

I. General information

NPI: 1982601076
Provider Name (Legal Business Name): MOUNTAIN HOME NURSING SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 MOUNTAIN HOME NURSING LN
HAYESVILLE NC
28904-5811
US

IV. Provider business mailing address

PO BOX 1306
HAYESVILLE NC
28904-1306
US

V. Phone/Fax

Practice location:
  • Phone: 828-389-8106
  • Fax: 828-389-8484
Mailing address:
  • Phone: 828-389-8106
  • Fax: 828-389-8484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHC0104
License Number StateNC

VIII. Authorized Official

Name: MRS. ANGELA H BARRETT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 828-389-8106