Healthcare Provider Details

I. General information

NPI: 1568281988
Provider Name (Legal Business Name): CARSON TAHOE REGIONAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 FLEISCHMANN WAY
CARSON CITY NV
89703-2995
US

IV. Provider business mailing address

PO BOX 2168
CARSON CITY NV
89702-2168
US

V. Phone/Fax

Practice location:
  • Phone: 775-445-8889
  • Fax:
Mailing address:
  • Phone: 775-445-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: KATIE KUCERA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 775-445-8672