Mountain Valley Healthcare LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

MOUNTAIN VALLEY HEALTHCARE LLC

Practice address

5816 E Shields Ave Ste 109
Fresno, CA 93727-8064

Phone

(669) 224-9120

NPI assigned

Sep 16, 2021

Last updated

Sep 16, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Abdul Marcaban Jr.

Title

Owner/President

Phone

(669) 224-9120

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780354209. Details of each certification follow.

• CCN 757850 Home health agency · Active · Details

Home health agency certification: CCN 757850

Legal name

MOUNTAIN VALLEY HEALTHCARE LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 8, 2024

Last certification

Oct 24, 2024

Organization structure

LLCProprietary

Incorporated

Sep 13, 2021 in CA

Enrollment address

5816 E Shields Ave
Ste 109
Fresno, CA 93727-8064

Listed as

Mountain Valley Healthcare LLCCCN 757850 · All quality measures

Ownership

-

Certified

Nov 8, 2024

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1631750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1780354209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5816 E SHIELDS AVE STE 109",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937278064",
            "telephone_number": "669-224-9120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5816 E SHIELDS AVE STE 109",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937278064",
            "telephone_number": "669-224-9120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN VALLEY HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-16",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "MARCABAN",
        "authorized_official_first_name": "ABDUL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "669-224-9120",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lyndon Patrick Moultrie Jr.
• Rayana Mounlaphasith
• Molly Elizabeth Mounsey
• Robo Mounsithirath
• Mountain Family Health Care Center, a Medical Corporation (Mountain Family Health Care Center)
• Mountain View Home Care Services
• Michael Emeel Mousa, M.D.
• Jana Mowrer, MPH, RDN
• Alexandra Moy Torres, LMFT
• Jeffrey Moy

• Home Health Agency in Fresno, CA
• Providers in Fresno, 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 Sep 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.