Provider Demographics
NPI:1114562667
Name:LONGEVITY RESIDENTIAL CARE II
Entity Type:Organization
Organization Name:LONGEVITY RESIDENTIAL CARE II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-843-9421
Mailing Address - Street 1:4073 KINGS ROW
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-6825
Mailing Address - Country:US
Mailing Address - Phone:775-622-9982
Mailing Address - Fax:775-622-9630
Practice Address - Street 1:4073 KINGS ROW
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-6825
Practice Address - Country:US
Practice Address - Phone:775-622-9982
Practice Address - Fax:775-622-9630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home