# MOUNTAIN STATES HEALTH ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ballad Health Homecare
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013195155
- **Authorized official:** MARY LYNN KRUTAK (EVP / CFO)
- **Authorized official phone:** (423) 302-3423

## Contact information

- **Practice address:** 75 S FLANNAGAN AVE, LEBANON, VA 24266
- **Practice address phone:** (276) 883-8484
- **Practice address fax:** (276) 883-8495
- **Mailing address:** 311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
- **Mailing address phone:** (276) 883-8484
- **Mailing address fax:** (276) 883-8495

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 01/31/2008
- **Last updated:** 02/26/2019