MEDICARE: MOUNTAIN VALLEY CARE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1952247470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VALLEY CARE, LLC

Provider Business Mailing Address
First Line	:	6002 S 17TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-4507
Country	:	US
Telephone Number	:	602-697-0429
Fax Number	:

Provider Business Practice Location Address
First Line	:	6002 S 17TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-4507
Country	:	US
Telephone Number	:	602-697-0429
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ABDELRAHIM ABDELRAHMAN
Credential	:
Telephone Number	:	602-697-0429

Provider Enumeration Date	:	04/27/2026
Last Update Date	:	04/27/2026

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