Organization
MOUNTAIN CAP OF W
Active
Other names
Medicaid Waiver
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LORI A WALKER (DIRECTOR)
(304) 765-7738
Entity
Organization
Contact information
Practice address
105 JERRY BURTON DR, SUTTON, WV 26601-9767
(304) 765-7738
(304) 765-7308
Mailing address
105 JERRY BURTON DR, SUTTON, WV 26601-9767
(304) 765-7738
(304) 765-7308
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0031226000
—
WV
Enumeration date
04/10/2007
Last updated
08/22/2020
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