Healthcare Provider Details

I. General information

NPI: 1255114708
Provider Name (Legal Business Name): MOUNTAIN VIEW RETREAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 JAFFREY RD
MARLBOROUGH NH
03455-2517
US

IV. Provider business mailing address

PO BOX 432
FITZWILLIAM NH
03447-0432
US

V. Phone/Fax

Practice location:
  • Phone: 603-213-0882
  • Fax:
Mailing address:
  • Phone: 603-912-7607
  • Fax: 603-379-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EVA SHEPARD
Title or Position: PROGRAM DIRECTOR
Credential: LCMHC, MLADC
Phone: 603-213-0882