Provider Demographics
NPI:1679278071
Name:MOUNTAIN MOMMA & FAMILY SERVICES, LLC
Entity type:Organization
Organization Name:MOUNTAIN MOMMA & FAMILY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/APRN PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:304-933-9085
Mailing Address - Street 1:976 TAYLOR SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-7496
Mailing Address - Country:US
Mailing Address - Phone:304-933-9085
Mailing Address - Fax:304-407-4964
Practice Address - Street 1:976 TAYLOR SCHOOL RD
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-7496
Practice Address - Country:US
Practice Address - Phone:304-933-9085
Practice Address - Fax:304-407-4964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)