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General NPI Number Information
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NPI Number | 1619375946
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Entity Type | Organization
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Legal Business Name | TAHOE HOUSE FAMILY SERVICES LLC
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Dates
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Enumeration Date | 12/18/2014
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 2710 EASTSHORE PL
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City | RENO
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State | NV
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Zip | 89509-4318
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Country | US
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Telephone | 775-544-0365
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Fax |
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Provider Business Mailing Address
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Address Line | 1022 WATT ST
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City | RENO
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State | NV
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Zip | 89509-2850
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Country | US
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Telephone | 775-544-0365
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DEKEN GOSSETT
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Credential |
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Telephone | 775-544-0365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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