Healthcare Provider Details

I. General information

NPI: 1942683339
Provider Name (Legal Business Name): MOUNTAIN EMPIRE OLDER CITIZENS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 3RD AVE E
BIG STONE GAP VA
24219-3115
US

IV. Provider business mailing address

PO BOX 888 1501 THIRD AVENUE EAST
BIG STONE GAP VA
24219-0888
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 TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TERESA SHOOP
Title or Position: ASSOCIATE ACCOUNTANT
Credential:
Phone: 276-523-4202