MEDICARE: TRUCKEE MEADOWS HEALTHCARE, INC.

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1891577060
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUCKEE MEADOWS HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	29222 RANCHO VIEJO RD STE 127
Second Line	:
City	:	SAN JUAN CAPISTRANO
State	:	CA
Zip	:	92675-1049
Country	:	US
Telephone Number	:	949-487-9500
Fax Number	:	949-540-3007

Provider Business Practice Location Address
First Line	:	1950 BARING BLVD
Second Line	:
City	:	SPARKS
State	:	NV
Zip	:	89434-6735
Country	:	US
Telephone Number	:	775-626-2224
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	SOON BURNAM
Credential	:
Telephone Number	:	949-540-1249

Provider Enumeration Date	:	10/20/2023
Last Update Date	:	08/23/2024

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