# MOUNTAIN CAP OF W

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicaid Waiver
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639292873
- **Authorized official:** MRS. LORI A WALKER (DIRECTOR)
- **Authorized official phone:** (304) 765-7738

## Contact information

- **Practice address:** 105 JERRY BURTON DR, SUTTON, WV 26601-9767
- **Practice address phone:** (304) 765-7738
- **Practice address fax:** (304) 765-7308
- **Mailing address:** 105 JERRY BURTON DR, SUTTON, WV 26601-9767
- **Mailing address phone:** (304) 765-7738
- **Mailing address fax:** (304) 765-7308

## Taxonomy

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

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 08/22/2020