Provider Demographics
NPI:1346010683
Name:SERVANT HEART SENIOR LIVING LLC
Entity Type:Organization
Organization Name:SERVANT HEART SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-229-2957
Mailing Address - Street 1:2225 JESTER CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2307
Mailing Address - Country:US
Mailing Address - Phone:775-787-2100
Mailing Address - Fax:
Practice Address - Street 1:2225 JESTER CT
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2307
Practice Address - Country:US
Practice Address - Phone:775-787-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1891578290Medicaid