# MOUNTAIN STATES HEALTH ALLIANCE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Mountain States Rehabilitation at RCMC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619357928
- **Authorized official:** MARY LYNN KRUTAK (EVP/CFO)
- **Authorized official phone:** (423) 302-3423

## Contact information

- **Practice address:** 111 S FLANNAGAN AVENUE, LEBANON, VA 24266-4515
- **Practice address phone:** (276) 883-8095
- **Practice address fax:** (276) 883-8097
- **Mailing address:** 311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
- **Mailing address phone:** (276) 883-8095
- **Mailing address fax:** (276) 883-8097

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | H 1892 | VA | Yes |

## Other

- **Enumeration date:** 06/02/2015
- **Last updated:** 03/29/2018