Healthcare Provider Details

I. General information

NPI: 1972534659
Provider Name (Legal Business Name): MOUNTAIN EMPIRE OLDER CITIZENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 THIRD AVENUE EAST
BIG STONE GAP VA
24219-3114
US

IV. Provider business mailing address

1520 3RD AVE E P. O. BOX 888
BIG STONE GAP VA
24219-3114
US

V. Phone/Fax

Practice location:
  • Phone: 276-523-4202
  • Fax: 276-523-4208
Mailing address:
  • Phone: 276-523-4202
  • Fax: 276-523-4208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL K PEASE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 276-523-4202