Healthcare Provider Details

I. General information

NPI: 1134405707
Provider Name (Legal Business Name): MOUNTAIN VISIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MAIN ST
MOSHEIM TN
37818-4017
US

IV. Provider business mailing address

15 MAIN ST
MOSHEIM TN
37818-4017
US

V. Phone/Fax

Practice location:
  • Phone: 423-422-7676
  • Fax: 423-422-7626
Mailing address:
  • Phone: 423-422-7676
  • Fax: 423-422-7626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: VICKIE BIBLE
Title or Position: PRESIDENT
Credential: RN
Phone: 423-422-7676