MOUNTAIN COMPREHENSIVE CARE CENTER INC. NPI 1114426863

NPI Information

NPI: 1114426863
Provider Name: MOUNTAIN COMPREHENSIVE CARE CENTER, INC.

Doing Business As: HOMEPLACE CLINIC LOUISA

Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 18D2045319

Address:
130 TOWN HILL RD
LOUISA, KY
ZIP 41230
Phone: (606) 638-9522
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MOUNTAIN COMPREHENSIVE CARE CENTER, INC. is a federally qualified health center (fqhc) clinic center in Louisa, KY. MOUNTAIN COMPREHENSIVE CARE CENTER, INC. NPI is 1114426863. The provider is registered as an organization entity type.
The provider Is Doing Business As Homeplace Clinic Louisa.

The provider's business location address is:

130 TOWN HILL RD
LOUISA, KY
ZIP 41230-389
Phone: (606) 638-9522
Fax: (606) 638-3548

The provider's authorized official is Roxann Cordial .
The authorized official title is Credentialing and has the following contact phone number (606) 886-8572.

The CLIA number assigned to this NPI record is 18D2045319 - other - cmhc with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/8/2018 and was last updated on 2/9/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QF0400X	Clinic/Center	Federally Qualified Health Center (FQHC)	700264	KENTUCKY	Yes

What is NPI?

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This page was last updated on: 5/5/2024

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