Healthcare Provider Details

I. General information

NPI: 1497077317
Provider Name (Legal Business Name): TAHOE BASIN HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2010
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 CARRIAGE CREST DR
CARSON CITY NV
89706-2623
US

IV. Provider business mailing address

1959 CARRIAGE CREST DR
CARSON CITY NV
89706-2623
US

V. Phone/Fax

Practice location:
  • Phone: 775-230-5677
  • Fax: 775-885-0739
Mailing address:
  • Phone: 775-230-5677
  • Fax: 775-885-0739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberNV20101036124
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberNV20101036124
License Number StateNV

VIII. Authorized Official

Name: MISS DANIELLE A HULL
Title or Position: OWNER
Credential:
Phone: 775-230-5677