=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811382757
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN VIEW ASSISTED LIVING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2015
-----------------------------------------------------
Last Update Date | 03/30/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 MINT LN
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-7450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-552-3493
-----------------------------------------------------
Fax | 828-552-3493
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 MINT LN
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28806-7450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-552-3493
-----------------------------------------------------
Fax | 828-552-3493
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JON J MCDONALD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 828-216-8373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number | FCL-011-346
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------