Provider Demographics
NPI:1356686810
Name:WILEY CARE HOMES, LLC
Entity Type:Organization
Organization Name:WILEY CARE HOMES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLNEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:775-343-6882
Mailing Address - Street 1:6679 N LATOUR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-9197
Mailing Address - Country:US
Mailing Address - Phone:775-343-6882
Mailing Address - Fax:775-384-9546
Practice Address - Street 1:6679 N LATOUR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-9197
Practice Address - Country:US
Practice Address - Phone:775-343-6882
Practice Address - Fax:775-384-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV82Medicaid
NV14Medicaid