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NPI Code Detail

MEDICARE: MOUNTAIN VALLEY CHILD AND FAMILY SERVICES, INC.

MEDICARE: MOUNTAIN VALLEY CHILD AND 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
1322D00000XEmotionally Disturbed Childrens' Residential Treatment Facility290300461CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100386OTHERCAMEDICAL PROVIDER

General Provider Information

NPI Number : 1922185578
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN VALLEY CHILD AND FAMILY SERVICES, INC.
Provider Business Mailing Address
First Line : 24077 STATE HIGHWAY 49
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-8519
Country : US
Telephone Number : 530-265-9057
Fax Number : 530-292-3803
Provider Business Practice Location Address
First Line : 24077 STATE HIGHWAY 49
Second Line :
City : NEVADA CITY
State : CA
Zip : 95959-8519
Country : US
Telephone Number : 530-265-9057
Fax Number : 530-292-3803
Authorized Official
Title or Position : CFO
Name : RICHARD MILHOUS
Credential :
Telephone Number : 530-265-9057
Provider Enumeration Date : 11/01/2006
Last Update Date : 02/21/2017

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