Provider Demographics
NPI:1306036389
Name:MOUNTAIN HOME CARE EQUIPMENT, INC.
Entity type:Organization
Organization Name:MOUNTAIN HOME CARE EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RHODES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-946-4494
Mailing Address - Street 1:200 INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 113
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-3722
Mailing Address - Country:US
Mailing Address - Phone:706-635-4494
Mailing Address - Fax:706-635-3910
Practice Address - Street 1:4147 E FIRST ST
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513-4527
Practice Address - Country:US
Practice Address - Phone:706-946-4494
Practice Address - Fax:706-946-3910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAIN HOME CARE EQUIPMENT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-26
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00319503BMedicaid
GA00319503BMedicaid