Mary Mountain Home Care LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

MARY MOUNTAIN HOME CARE LLC

Practice address

11203 Malat Way
Culver City, CA 90230-5501

Phone

(818) 669-6780

NPI assigned

Aug 15, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Angie Nance

Title

President

Phone

(818) 669-6780

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1457079675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 S SEPULVEDA BLVD STE 1100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900347090",
            "telephone_number": "888-551-6557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11203 MALAT WAY",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902305501",
            "telephone_number": "818-669-6780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY MOUNTAIN HOME CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "NANCE",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-669-6780",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Christian Martinho, DPT
• Diana Martinon
• Maria Delores Martinson
• Michelle Theresa Mary Martonick
• Kersti Marusich, DPT
• Marycrest Manor
• Stephen Tyler Mascaro
• Sarita Aludor Maskall
• Lusine Maslakyan, MSW
• Felesia Lagale Mason

• In Home Supportive Care Agency in Culver City, CA
• Providers in Culver City, CA by specialty
• In Home Supportive Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.