Provider Demographics
NPI:1114364783
Name:BAINE, JAMES ERICH
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:ERICH
Last Name:BAINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 34 BOX 34165
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-9206
Mailing Address - Country:US
Mailing Address - Phone:775-238-5100
Mailing Address - Fax:775-238-5103
Practice Address - Street 1:HC 34 BOX 34165
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-9206
Practice Address - Country:US
Practice Address - Phone:775-238-5100
Practice Address - Fax:775-238-5103
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1389-13322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children