Organization
MOUNTAIN STATES HEALTH ALLIANCE
Active
Other names
Ballad Health Homecare
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LYNN KRUTAK (EVP/CFO)
(423) 302-3427
Entity
Organization
Contact information
Practice address
1205 SNIDER ST, MARION, VA 24354-4221
(276) 782-9696
(276) 782-9886
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(276) 782-9696
(276) 782-9886
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
H1902
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004970993
—
VA
01
—
083894
TRIGON BC/BS
VA
Enumeration date
06/22/2005
Last updated
07/11/2022
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