Healthcare Provider Details

I. General information

NPI: 1992498521
Provider Name (Legal Business Name): TAHOE COALITION FOR THE HOMELESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1137 EMERALD BAY RD OFC
SOUTH LAKE TAHOE CA
96150-6362
US

IV. Provider business mailing address

PO BOX 13514
SOUTH LAKE TAHOE CA
96151-3514
US

V. Phone/Fax

Practice location:
  • Phone: 530-600-2822
  • Fax:
Mailing address:
  • Phone: 530-600-2822
  • Fax: 530-464-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: CORY RENNEY
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 530-208-9447