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General NPI Number Information
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NPI Number | 1699907972
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Entity Type | Organization
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Legal Business Name | MOUNTAIN OUTREACH INC.
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 450 VEST TALCUM ROAD
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City | VEST
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State | KY
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Zip | 41772
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Country | US
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Telephone | 606-785-9320
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Fax | 606-785-9347
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Provider Business Mailing Address
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Address Line | PO BOX 271
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City | NEON
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State | KY
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Zip | 41840-0271
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Country | US
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Telephone | 606-832-9026
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Fax | 606-832-9061
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DIANE MORRIS
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Credential |
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Telephone | 606-832-9026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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