Healthcare Provider Details

I. General information

NPI: 1336141779
Provider Name (Legal Business Name): MOUNTAIN REGION PERSONAL CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 DUFF-PATT HWY
DUFFIELD VA
24244
US

IV. Provider business mailing address

PO BOX 246
DUFFIELD VA
24244
US

V. Phone/Fax

Practice location:
  • Phone: 276-431-1440
  • Fax: 276-431-1442
Mailing address:
  • Phone: 276-431-1440
  • Fax: 276-431-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number009105271
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4552980001
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number008773106
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number
License Number StateVA
# 8
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number497592
License Number StateVA

VIII. Authorized Official

Name: MRS. JUDY A. HILL
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 276-431-1440