Provider Demographics
NPI:1215932587
Name:MOUNTAIN HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:MOUNTAIN HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-758-4786
Mailing Address - Street 1:PO BOX 2566
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-2566
Mailing Address - Country:US
Mailing Address - Phone:575-758-4786
Mailing Address - Fax:575-758-0560
Practice Address - Street 1:630 PASEO DEL PUEBLO SUR
Practice Address - Street 2:# 180
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-7023
Practice Address - Country:US
Practice Address - Phone:505-758-1024
Practice Address - Fax:505-758-0560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-14
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6058A1251E00000X
NM6479251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH4874Medicaid
NMN1078Medicaid
NMD0693Medicaid
NM73583Medicaid
NM321531Medicare ID - Type UnspecifiedMEDICARE HOSPICE PROVIDER
NM327010Medicare ID - Type Unspecified