Basic Information
| Provider Information | |||||||||
| NPI: | 1649613886 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NEW LIFECARE HOSPITALS OF NORTHERN NEVADA LLC | ||||||||
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| OtherOrganizationName: | TAHOE PACIFIC HOSPITALS - NORTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5340 LEGACY DR | ||||||||
| Address2: | SUITE150 | ||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750243178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4692412128 | ||||||||
| FaxNumber: | 4692412177 | ||||||||
| Practice Location | |||||||||
| Address1: | 10101 DOUBLE R BLVD | ||||||||
| Address2: | 1ST FLOOR | ||||||||
| City: | RENO | ||||||||
| State: | NV | ||||||||
| PostalCode: | 895215931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7753311044 | ||||||||
| FaxNumber: | 7753555603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2013 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | CRONIN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT - REIMBURSEMENT | ||||||||
| AuthorizedOfficialTelephone: | 4692412128 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | 3878HOS-14 | NV | Y | Hospitals | Long Term Care Hospital |
No ID Information.