Healthcare Provider Details

I. General information

NPI: 1457515850
Provider Name (Legal Business Name): BRISTLECONE FAMILY RESOURCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 MILL ST
RENO NV
89502-1321
US

IV. Provider business mailing address

704 MILL ST
RENO NV
89502-1321
US

V. Phone/Fax

Practice location:
  • Phone: 775-954-1400
  • Fax: 775-954-1406
Mailing address:
  • Phone: 775-954-1400
  • Fax: 775-954-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER OTT
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 775-954-1400