Healthcare Provider Details

I. General information

NPI: 1750900510
Provider Name (Legal Business Name): CAREMERIDIAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 LAKE PLACID DR
RENO NV
89511-6702
US

IV. Provider business mailing address

163 TECHNOLOGY DR STE 200
IRVINE CA
92618-2486
US

V. Phone/Fax

Practice location:
  • Phone: 775-470-5584
  • Fax:
Mailing address:
  • Phone: 949-794-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN LEE
Title or Position: BUSINESS MANAGER
Credential:
Phone: 949-794-0787