Provider Demographics
NPI:1841324266
Name:MOUNTAIN VIEW FAMILY CARE HOME #1
Entity type:Organization
Organization Name:MOUNTAIN VIEW FAMILY CARE HOME #1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:PEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-584-8159
Mailing Address - Street 1:5820 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-7931
Mailing Address - Country:US
Mailing Address - Phone:828-584-8159
Mailing Address - Fax:828-584-8159
Practice Address - Street 1:5820 HOLLAND ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-7931
Practice Address - Country:US
Practice Address - Phone:828-584-8159
Practice Address - Fax:828-584-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCFCL 012013310400000X
NCFCL 012016310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7803625Medicaid
NC7803624Medicaid