Black Mountain, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

BLACK MOUNTAIN, LLC

Practice address

177 Bovet Rd
Suite 130
San Mateo, CA 94402-3116

Phone

(650) 785-2800

Fax

(650) 785-2801

NPI assigned

Dec 3, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jake Caruso

Title

Managing Director

Phone

(650) 785-2800

Specialties & licenses 1

Addresses

Other names 1

• Interim HealthCare Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1449100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449100800000",
    "number": "1396110219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 72",
            "city": "BURLINGAME",
            "state": "CA",
            "postal_code": "940110072",
            "telephone_number": "650-785-2800",
            "fax_number": "650-785-2801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 BOVET RD",
            "address_2": "SUITE 130",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944023116",
            "telephone_number": "650-785-2800",
            "fax_number": "650-785-2801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK MOUNTAIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-03",
        "last_updated": "2015-12-03",
        "status": "A",
        "authorized_official_last_name": "CARUSO",
        "authorized_official_first_name": "JAKE",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "650-785-2800"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Interim HealthCare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Julie Aimee Birdsong, RN, CNM, WHNP
• Faina Birman, NP
• Eliane Bitar, MD
• Brianna Cheri Bitz
• Anita Bivens, M.S.
• Catrina Patricia Blake, FNP
• Chantel Marie Blanco
• John Andrew Blenio, D.C.
• Shawntal Renee Blevins
• Jessica Blois, M.A.

• Home Health Agency in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Home Health Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.