Provider Demographics
NPI:1124101191
Name:MOUNTAIN VIEW RETIREMENT HOME INC
Entity type:Organization
Organization Name:MOUNTAIN VIEW RETIREMENT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DON
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-889-3611
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-889-3611
Mailing Address - Fax:276-889-2284
Practice Address - Street 1:ROUTE 660
Practice Address - Street 2:2336 COAL TIPPLE HALLAR
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-889-3611
Practice Address - Fax:276-889-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility