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) 302-3423
Entity
Organization
Contact information
Practice address
312 HOSPITAL DR SUITE 1A, CLINTWOOD, VA 24228
(276) 926-6600
(276) 926-6783
Mailing address
311 PRINCETON RD STE 1, JOHNSON CITY, TN 37601-2026
(276) 926-6600
(276) 926-6783
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
497601
MEDICARE
VA
Enumeration date
06/06/2017
Last updated
02/19/2019
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