Healthcare Provider Details

I. General information

NPI: 1518829753
Provider Name (Legal Business Name): WATERFIELD SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3056 WATERFIELD DR
SPARKS NV
89434-1627
US

IV. Provider business mailing address

3056 WATERFIELD DR
SPARKS NV
89434-1627
US

V. Phone/Fax

Practice location:
  • Phone: 775-232-6038
  • Fax:
Mailing address:
  • Phone: 775-232-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. MARIO REYES
Title or Position: OWNER
Credential:
Phone: 775-232-6038