Provider Demographics
NPI:1962536219
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:CO-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:706-635-4494
Mailing Address - Street 1:PO BOX 675
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-0009
Mailing Address - Country:US
Mailing Address - Phone:706-635-4494
Mailing Address - Fax:706-635-3910
Practice Address - Street 1:200 INDUSTRIAL BLVD STE 113
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-3721
Practice Address - Country:US
Practice Address - Phone:706-635-4494
Practice Address - Fax:706-635-3910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00319503AMedicaid
GA1669435715OtherNPI
GA00319503AMedicaid