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General NPI Number Information
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NPI Number | 1386857167
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Entity Type | Organization
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Legal Business Name | MOUNTAIN CIRCLE
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 4600 KIETZKE LN STE O260
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City | RENO
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State | NV
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Zip | 89502-5046
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Country | US
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Telephone | 775-825-9060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 554
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City | GREENVILLE
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State | CA
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Zip | 95947
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Country | US
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Telephone | 530-284-7007
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Fax | 530-284-7111
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Authorized Official
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Title or Position | CEO
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Name | SHAUNA ROSSINGTON
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Credential |
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Telephone | 530-284-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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