Provider Demographics
NPI:1326019688
Name:RENOWN REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:RENOWN REGIONAL MEDICAL CENTER
Other - Org Name:RENOWN HEALTH HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO ACUTE CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-982-6343
Mailing Address - Street 1:10315 PROFESSIONAL CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4803
Mailing Address - Country:US
Mailing Address - Phone:775-982-2828
Mailing Address - Fax:775-982-5870
Practice Address - Street 1:10315 PROFESSIONAL CIR STE 101
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-4803
Practice Address - Country:US
Practice Address - Phone:775-982-2828
Practice Address - Fax:775-982-5870
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RENOWN REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-26
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV627HHA-10251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV297015Medicare Oscar/Certification