Provider Demographics
NPI:1114563608
Name:SIERRA SERENITY PROVIDERS, LLC.
Entity Type:Organization
Organization Name:SIERRA SERENITY PROVIDERS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-432-1035
Mailing Address - Street 1:515 E GAULT WAY
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-2482
Mailing Address - Country:US
Mailing Address - Phone:775-432-1035
Mailing Address - Fax:775-384-6685
Practice Address - Street 1:515 E GAULT WAY
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-2482
Practice Address - Country:US
Practice Address - Phone:775-432-1035
Practice Address - Fax:775-384-6685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care