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General NPI Number Information
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NPI Number | 1386531242
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Entity Type | Organization
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Legal Business Name | CARESOURCE NEVADA CO.
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Dates
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Enumeration Date | 06/23/2025
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Last Update Date | 06/23/2025
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Provider Practice Location Address
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Address Line | 6385 S RAINBOW BLVD STE 500
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City | LAS VEGAS
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State | NV
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Zip | 89118-3201
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Country | US
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Telephone | 725-332-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 230 N MAIN ST
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City | DAYTON
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State | OH
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Zip | 45402-1263
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Country | US
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Telephone | 937-224-3000
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAYME PUU
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Credential |
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Telephone | 937-974-3518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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