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General NPI Number Information
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NPI Number | 1407275639
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Entity Type | Organization
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Legal Business Name | MOUNTAIN TOP ALF LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 414 MASSEY AVE
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-6132
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Country | US
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Telephone | 870-269-5845
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Fax | 870-269-2172
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Provider Business Mailing Address
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Address Line | 414 MASSEY AVE
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-6132
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Country | US
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Telephone | 870-269-5845
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Fax | 870-269-2172
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | BOYD GENTRY
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Credential |
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Telephone | 678-869-5116
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 493
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License Number State | AR
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