Healthcare Provider Details

I. General information

NPI: 1952185779
Provider Name (Legal Business Name): MOUNTAIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 H ST APT C
LAS VEGAS NV
89106-2544
US

IV. Provider business mailing address

2300 W SAHARA AVE STE 800
LAS VEGAS NV
89102-4397
US

V. Phone/Fax

Practice location:
  • Phone: 725-251-3362
  • Fax: 702-549-1915
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ABDUL COOPER
Title or Position: ADMINISTRATOR
Credential:
Phone: 510-393-5306