Provider Demographics
NPI:1366005845
Name:JADE NOBE CLINIC-JHMC, LLC
Entity Type:Organization
Organization Name:JADE NOBE CLINIC-JHMC, LLC
Other - Org Name:JADE HOUSE MANAGED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTINA
Authorized Official - Middle Name:GISELLE
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP/APRNC
Authorized Official - Phone:775-623-9120
Mailing Address - Street 1:PO BOX 344
Mailing Address - Street 2:
Mailing Address - City:MC DERMITT
Mailing Address - State:NV
Mailing Address - Zip Code:89421-0344
Mailing Address - Country:US
Mailing Address - Phone:775-623-9120
Mailing Address - Fax:775-623-9140
Practice Address - Street 1:200 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-3413
Practice Address - Country:US
Practice Address - Phone:775-623-9120
Practice Address - Fax:775-623-9140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251F00000XAgenciesHome Infusion
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100544708Medicaid