MEDICARE: SIERRA VISTA SENIOR LIVING, LLC

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		NV

General Provider Information

NPI Number	:	1609190990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIERRA VISTA SENIOR LIVING, LLC

Provider Business Mailing Address
First Line	:	210 S ORMSBY BLVD
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4549
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 S ORMSBY BLVD
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4549
Country	:	US
Telephone Number	:	775-771-2525
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARK ROBERT FORSBERG
Credential	:
Telephone Number	:	775-771-2525

Provider Enumeration Date	:	03/16/2010
Last Update Date	:	03/16/2010

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