Provider Demographics
NPI:1538368097
Name:MOUTAIN, VALLEY AND SHORE MOBILE
Entity type:Organization
Organization Name:MOUTAIN, VALLEY AND SHORE MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DARLIA
Authorized Official - Middle Name:MELVINIA
Authorized Official - Last Name:MCPHERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DIPL, RN, BSN, MA
Authorized Official - Phone:301-490-8236
Mailing Address - Street 1:11600 BASSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3170
Mailing Address - Country:US
Mailing Address - Phone:301-490-8236
Mailing Address - Fax:124-055-4258
Practice Address - Street 1:11600 BASSWOOD DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-3170
Practice Address - Country:US
Practice Address - Phone:301-490-8236
Practice Address - Fax:124-055-4258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-15
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN58013251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare