# MOUNTAIN STATES HEALTH ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medical Center Homecare Services
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548376718
- **Authorized official:** MARY LYNN KRUTAK (EVP/CFO)
- **Authorized official phone:** (423) 302-3423

## Contact information

- **Practice address:** 509 MED TECH PKWY, SUITE 200, JOHNSON CITY, TN 37604-2578
- **Practice address phone:** (423) 431-6146
- **Practice address fax:** (423) 431-5733
- **Mailing address:** 311 PRINCETON RD, SUITE 1, JOHNSON CITY, TN 37601-2026
- **Mailing address phone:** (423) 431-6146
- **Mailing address fax:** (423) 431-5733

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 0000000271 | TN | Yes |

## Other

- **Enumeration date:** 08/21/2006
- **Last updated:** 02/21/2018