Provider Demographics
NPI:1447818018
Name:MOUNTAIN MANA CORP.
Entity type:Organization
Organization Name:MOUNTAIN MANA CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-904-3285
Mailing Address - Street 1:975 E WOODOAK LN STE 230
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-7275
Mailing Address - Country:US
Mailing Address - Phone:801-904-3285
Mailing Address - Fax:385-347-5957
Practice Address - Street 1:975 E WOODOAK LN STE 230
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84117-7275
Practice Address - Country:US
Practice Address - Phone:801-904-3285
Practice Address - Fax:385-347-5957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care