Provider Demographics
NPI:1699907972
Name:MOUNTAIN OUTREACH INC.
Entity type:Organization
Organization Name:MOUNTAIN OUTREACH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-832-9026
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:NEON
Mailing Address - State:KY
Mailing Address - Zip Code:41840-0271
Mailing Address - Country:US
Mailing Address - Phone:606-832-9026
Mailing Address - Fax:606-832-9061
Practice Address - Street 1:450 VEST TALCUM ROAD
Practice Address - Street 2:
Practice Address - City:VEST
Practice Address - State:KY
Practice Address - Zip Code:41772
Practice Address - Country:US
Practice Address - Phone:606-785-9320
Practice Address - Fax:606-785-9347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care