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General NPI Number Information
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NPI Number | 1851831705
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Entity Type | Organization
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Legal Business Name | MOUNTAIN HHA, LLC
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Dates
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Enumeration Date | 02/26/2017
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Last Update Date | 12/09/2019
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Provider Practice Location Address
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Address Line | 516 BLUE RIDGE ST STE A
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City | BLAIRSVILLE
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State | GA
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Zip | 30512-3159
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Country | US
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Telephone | 706-745-5101
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Fax | 706-745-5139
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Provider Business Mailing Address
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Address Line | 1395 S MARIETTA PKWY SE BLDG 400 SUITE 102
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City | MARIETTA
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State | GA
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Zip | 30067-4440
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Country | US
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Telephone | 678-932-6302
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Fax | 678-402-5246
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY W RASMUSSEN
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Credential |
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Telephone | 671-932-6302
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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 | 144-132
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License Number State | GA
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