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General NPI Number Information
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NPI Number | 1114563608
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Entity Type | Organization
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Legal Business Name | SIERRA SERENITY PROVIDERS, LLC.
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Dates
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Enumeration Date | 11/20/2019
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Last Update Date | 11/21/2019
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Provider Practice Location Address
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Address Line | 515 E GAULT WAY
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City | SPARKS
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State | NV
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Zip | 89431-2482
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Country | US
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Telephone | 775-432-1035
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Fax | 775-384-6685
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Provider Business Mailing Address
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Address Line | 515 E GAULT WAY
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City | SPARKS
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State | NV
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Zip | 89431-2482
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Country | US
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Telephone | 775-432-1035
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Fax | 775-384-6685
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ERICA CHRISTINE YOUNG
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Credential |
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Telephone | 775-432-1035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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