MEDICARE: ORMSBY HEIGHTS RESIDENTIAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	7687AGC-5	NV
2	310400000X	Assisted Living Facility	7210AGC-3	NV

General Provider Information

NPI Number	:	1336674985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORMSBY HEIGHTS RESIDENTIAL CARE

Provider Business Mailing Address
First Line	:	210 S ORMSBY BLVD
Second Line	:	615 W. 5TH ST
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4549
Country	:	US
Telephone Number	:	775-445-0214
Fax Number	:	775-883-3116

Provider Business Practice Location Address
First Line	:	210 S ORMSBY BLVD
Second Line	:	615 W. 5TH ST
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4549
Country	:	US
Telephone Number	:	775-445-0214
Fax Number	:	775-883-3116

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTI N JOHNSON
Credential	:
Telephone Number	:	775-450-8740

Provider Enumeration Date	:	04/20/2017
Last Update Date	:	04/20/2017

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