MEDICARE: MOUNTAIN VALLEY SUPPORTED LIVING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251C00000X	Developmentally Disabled Services Day Training Agency
2	251S00000X	Community/Behavioral Health Agency
3	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1760331284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VALLEY SUPPORTED LIVING

Provider Business Mailing Address
First Line	:	7362 W PARKS HWY # 834
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623-9300
Country	:	US
Telephone Number	:	907-841-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	172 S LAMONT CIR
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99623-9300
Country	:	US
Telephone Number	:	907-841-6400
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	KERRIE SPAIN
Credential	:
Telephone Number	:	907-841-6400

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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Directions to “MOUNTAIN VALLEY SUPPORTED LIVING ” Practice Location

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