Healthcare Provider Details

I. General information

NPI: 1386857167
Provider Name (Legal Business Name): MOUNTAIN CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 KIETZKE LN STE O260
RENO NV
89502-5046
US

IV. Provider business mailing address

PO BOX 554
GREENVILLE CA
95947
US

V. Phone/Fax

Practice location:
  • Phone: 775-825-9060
  • Fax:
Mailing address:
  • Phone: 530-284-7007
  • Fax: 530-284-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: SHAUNA ROSSINGTON
Title or Position: CEO
Credential:
Phone: 530-284-7007