Healthcare Provider Details

I. General information

NPI: 1417394792
Provider Name (Legal Business Name): WESTCARE NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 RECORD ST STE 103
RENO NV
89512-3327
US

IV. Provider business mailing address

401 S MARTIN LUTHER KING BLVD
LAS VEGAS NV
89106-4313
US

V. Phone/Fax

Practice location:
  • Phone: 775-996-1970
  • Fax: 775-786-2418
Mailing address:
  • Phone: 702-385-3642
  • Fax: 702-924-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: AMY ROUKIE
Title or Position: VICE PRESIDENT
Credential:
Phone: 775-348-8811