Provider Demographics
NPI:1861700379
Name:MOUNTAIN HERITAGE BUILDERS LLC
Entity type:Organization
Organization Name:MOUNTAIN HERITAGE BUILDERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SALVATI
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:423-232-6440
Mailing Address - Street 1:100 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5773
Mailing Address - Country:US
Mailing Address - Phone:423-232-6440
Mailing Address - Fax:888-726-5506
Practice Address - Street 1:100 SPRING ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5773
Practice Address - Country:US
Practice Address - Phone:423-232-6440
Practice Address - Fax:888-726-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30967332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment