Healthcare Provider Details

I. General information

NPI: 1205274834
Provider Name (Legal Business Name): ROBERT WILLIAM STONE CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 HWY 395 N, SUITE 3
GARDNERVILLE NV
89423
US

IV. Provider business mailing address

1512 HWY 395 N, SUITE 3
GARDNERVILLE NV
89423
US

V. Phone/Fax

Practice location:
  • Phone: 775-782-4202
  • Fax: 775-782-5055
Mailing address:
  • Phone: 775-782-4202
  • Fax: 775-782-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number00312-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: