=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639538390
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HIGHLANDS OF MOUNTAIN VIEW RCF HOLDINGS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2016
-----------------------------------------------------
Last Update Date | 02/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 414 MASSEY AVE
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72560-6132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-269-5845
-----------------------------------------------------
Fax | 870-269-2172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 414 MASSEY AVE
-----------------------------------------------------
City | MOUNTAIN VIEW
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72560-6132
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-269-5845
-----------------------------------------------------
Fax | 870-269-2172
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | JOSEPH SCHWARTZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 201-635-1195
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311Z00000X
-----------------------------------------------------
Taxonomy Name | Custodial Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------