# HEART MOUNTAIN CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1467162081
- **Authorized official:** MISS SHAY NICOLE BALES CNA (OWNER)
- **Authorized official phone:** (307) 219-8509

## Contact information

- **Practice address:** 333 S JONES ST LOT 4, POWELL, WY 82435-3103
- **Practice address phone:** (307) 219-8509
- **Mailing address:** 333 S JONES ST LOT 4, POWELL, WY 82435-3103
- **Mailing address phone:** (307) 219-8509

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251C00000X | Developmentally Disabled Services Day Training Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |
| 261QD1600X | Developmental Disabilities Clinic/Center | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM0850X | Adult Mental Health Clinic/Center | — | NULL | — |
| 261QM0855X | Adolescent and Children Mental Health Clinic/Center | — | NULL | — |
| 3104A0625X | Assisted Living Facility (Mental Illness) | — | NULL | — |
| 310500000X | Mental Illness Intermediate Care Facility | — | NULL | — |
| 385HR2060X | Child Intellectual and/or Developmental Disabilities Respite Care | — | NULL | — |

## Other

- **Enumeration date:** 12/05/2022
- **Last updated:** 12/05/2022