Provider Demographics
NPI:1386857167
Name:MOUNTAIN CIRCLE
Entity type:Organization
Organization Name:MOUNTAIN CIRCLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-284-7007
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95947
Mailing Address - Country:US
Mailing Address - Phone:530-284-7007
Mailing Address - Fax:530-284-7111
Practice Address - Street 1:4600 KIETZKE LN STE O260
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-5046
Practice Address - Country:US
Practice Address - Phone:775-825-9060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100509693Medicaid