Healthcare Provider Details

I. General information

NPI: 1043531890
Provider Name (Legal Business Name): ANGEL'S HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13320 STONELAND DR
RENO NV
89511-5904
US

IV. Provider business mailing address

13320 STONELAND DR
RENO NV
89511-5904
US

V. Phone/Fax

Practice location:
  • Phone: 775-852-2127
  • Fax:
Mailing address:
  • Phone: 775-852-2127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number105481
License Number StateNV

VIII. Authorized Official

Name: MISS MARIA S OLIVEIRA
Title or Position: DIRECTOR/OWNER
Credential:
Phone: 775-852-2127