Basic Information
| Provider Information | |||||||||
| NPI: | 1073054110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDTRANS FAYLONA LLC | ||||||||
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| OtherOrganizationName: | WELL CARE MEDICAL AND BEHAVIORAL CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 790 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021304 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 790 WILLOW ST | ||||||||
| Address2: | |||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895021304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7755386700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2017 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | MALINIS | ||||||||
| AuthorizedOfficialFirstName: | FRANCES | ||||||||
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| AuthorizedOfficialTitleorPosition: | COMPLIANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7024107825 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.