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General NPI Number Information
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NPI Number | 1619972213
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Entity Type | Organization
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Legal Business Name | MOUNTAINLIFE HOME CARE, INC.
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Dates
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Enumeration Date | 06/20/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 411 S MAIN ST
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City | JEFFERSON
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State | NC
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Zip | 28640-9519
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Country | US
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Telephone | 336-846-1784
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Fax | 336-846-1785
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Provider Business Mailing Address
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Address Line | PO BOX 1784
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City | WEST JEFFERSON
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State | NC
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Zip | 28694-1784
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Country | US
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Telephone | 336-846-1784
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Fax | 336-846-1785
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Authorized Official
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Title or Position | DIRECTOR/PRESIDENT
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Name | MR. EDWARD W. HAMMITT
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Credential | RN
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Telephone | 336-846-1784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HC2576
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License Number State | NC
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