MEDICARE: MOUNTAIN SPRINGS COMMUNITY SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	385H00000X	Respite Care

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275119810
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN SPRINGS COMMUNITY SERVICES LLC

Provider Business Mailing Address
First Line	:	2866 N WALNUT AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1512
Country	:	US
Telephone Number	:	520-955-4539
Fax Number	:

Provider Business Practice Location Address
First Line	:	2866 N WALNUT AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85712-1512
Country	:	US
Telephone Number	:	520-955-4539
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATIVE MANAGER/OWNER
Name	:	MR. ZACHARY R HARRIS
Credential	:
Telephone Number	:	520-955-4539

Provider Enumeration Date	:	03/23/2021
Last Update Date	:	03/23/2021

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