Provider Demographics
NPI:1225259690
Name:MOUNTAIN SPRINGS ASSISTED LIVING
Entity Type:Organization
Organization Name:MOUNTAIN SPRINGS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MAOM
Authorized Official - Phone:775-885-9223
Mailing Address - Street 1:2861 MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-1539
Mailing Address - Country:US
Mailing Address - Phone:775-885-9223
Mailing Address - Fax:775-885-8050
Practice Address - Street 1:2861 MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-1539
Practice Address - Country:US
Practice Address - Phone:775-885-9223
Practice Address - Fax:775-885-8050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV313AGC-133104A0630X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV005713015Medicaid