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General NPI Number Information
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NPI Number | 1669993572
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Entity Type | Organization
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Legal Business Name | ST. PAUL'S HOME CARE III
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Dates
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Enumeration Date | 06/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4910 KOENIG ROAD
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City | RENO
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State | NV
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Zip | 89506-7811
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Country | US
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Telephone | 775-657-6483
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Fax | 775-453-2263
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Provider Business Mailing Address
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Address Line | 4910 KOENIG RD
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City | RENO
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State | NV
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Zip | 89506-7811
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Country | US
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Telephone | 775-657-6483
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Fax | 775-453-2263
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Authorized Official
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Title or Position | OWNER
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Name | JERIS BELTEJAR
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Credential |
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Telephone | 775-657-6483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 7195-AGC-6
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License Number State | NV
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