Healthcare Provider Details

I. General information

NPI: 1679939904
Provider Name (Legal Business Name): MT. OLIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2015
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1281 TERMINAL WAY SUITE 201
RENO NV
89502-3220
US

IV. Provider business mailing address

1281 TERMINAL WAY SUITE 201
RENO NV
89502-3220
US

V. Phone/Fax

Practice location:
  • Phone: 775-544-5618
  • Fax: 775-348-4986
Mailing address:
  • Phone: 775-544-5618
  • Fax: 775-348-4986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SIONE K AONGA
Title or Position: OWNER/DIRECTOR
Credential:
Phone: 775-544-5618