Provider Demographics
NPI:1174005987
Name:SIERRA INTELLIGENCE GROUP, LLC
Entity Type:Organization
Organization Name:SIERRA INTELLIGENCE GROUP, LLC
Other - Org Name:WASHOE SENIOR LIVING I
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:RFA
Authorized Official - Phone:775-688-9670
Mailing Address - Street 1:14765 CHATEAU AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-4519
Mailing Address - Country:US
Mailing Address - Phone:775-688-9670
Mailing Address - Fax:775-376-8761
Practice Address - Street 1:4190 BISMARCK DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6306
Practice Address - Country:US
Practice Address - Phone:775-688-9670
Practice Address - Fax:775-737-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home