Healthcare Provider Details

I. General information

NPI: 1508076183
Provider Name (Legal Business Name): LITTLE ANGEL CARE HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 KEYSTONE AVE
RENO NV
89503-1364
US

IV. Provider business mailing address

2570 KEYSTONE AVE
RENO NV
89503-1364
US

V. Phone/Fax

Practice location:
  • Phone: 775-746-8027
  • Fax: 775-746-9256
Mailing address:
  • Phone: 775-746-8027
  • Fax: 775-746-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateNV

VIII. Authorized Official

Name: MARILOU A REYES
Title or Position: OWNER
Credential:
Phone: 775-746-8027