Healthcare Provider Details

I. General information

NPI: 1700530979
Provider Name (Legal Business Name): RENO CENTER FOR CHILDREN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1698 MEADOW WOOD LN
RENO NV
89502-6707
US

IV. Provider business mailing address

4569 WINDCREST DR
RENO NV
89523-9421
US

V. Phone/Fax

Practice location:
  • Phone: 208-340-7855
  • Fax:
Mailing address:
  • Phone: 208-340-7855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: SHANNON BURRESS
Title or Position: CLINICAL DIRECTOR
Credential:
Phone: 208-340-7855