Provider Demographics
NPI:1033730155
Name:BACK MOUNTAIN HOME CARE,LLC
Entity type:Organization
Organization Name:BACK MOUNTAIN HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEEKER
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:570-574-4587
Mailing Address - Street 1:1847 STATE ROUTE 29 HWY
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-4220
Mailing Address - Country:US
Mailing Address - Phone:570-574-4587
Mailing Address - Fax:
Practice Address - Street 1:1847 STATE ROUTE 29 HWY
Practice Address - Street 2:
Practice Address - City:HUNLOCK CREEK
Practice Address - State:PA
Practice Address - Zip Code:18621-4220
Practice Address - Country:US
Practice Address - Phone:570-574-4587
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty