Healthcare Provider Details

I. General information

NPI: 1255269973
Provider Name (Legal Business Name): SKYLINE MOUNTAIN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 MOUNTAIN ST
CARSON CITY NV
89703-1539
US

IV. Provider business mailing address

2861 MOUNTAIN ST
CARSON CITY NV
89703-1539
US

V. Phone/Fax

Practice location:
  • Phone: 775-885-9223
  • Fax:
Mailing address:
  • Phone: 775-885-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER PAUL O'DONNELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 775-885-9223