MEDICARE: MOUNTAIN CIRCLE FAMILY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

General Provider Information

NPI Number	:	1023075082
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN CIRCLE FAMILY SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 554
Second Line	:
City	:	GREENVILLE
State	:	CA
Zip	:	95947-0554
Country	:	US
Telephone Number	:	530-284-7007
Fax Number	:	530-284-7111

Provider Business Practice Location Address
First Line	:	4600 KIETZKE LN
Second Line	:	SUITE B112
City	:	RENO
State	:	NV
Zip	:	89502-5033
Country	:	US
Telephone Number	:	775-825-9995
Fax Number	:	775-825-9877

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MISS BRENDA SUE O'BRYANT
Credential	:
Telephone Number	:	530-284-7007

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	08/22/2020

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