Organization
BLACK MOUNTAIN, LLC
Active
Other names
Interim HealthCare
Organization subpart
No
Provider details
NPI number
Authorized official
JAKE CARUSO (MANAGING DIRECTOR)
(650) 785-2800
Entity
Organization
Contact information
Practice address
177 BOVET RD, SUITE 130, SAN MATEO, CA 94402-3116
(650) 785-2800
(650) 785-2801
Mailing address
PO BOX 72, BURLINGAME, CA 94011-0072
(650) 785-2800
(650) 785-2801
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
12/03/2015
Last updated
12/03/2015
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