Healthcare Provider Details

I. General information

NPI: 1538174123
Provider Name (Legal Business Name): TAHOE FOREST HOSPITAL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10956 DONNER PASS RD
TRUCKEE CA
96161-4861
US

IV. Provider business mailing address

10956 DONNER PASS RD
TRUCKEE CA
96161-4861
US

V. Phone/Fax

Practice location:
  • Phone: 530-587-7607
  • Fax: 530-587-6771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHY41861
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: BILJANA MILICEVIC
Title or Position: MANAGER
Credential:
Phone: 530-587-7607