Provider Demographics
NPI:1437183357
Name:LIFECARE HOSPITALS OF NORTHERN NEVADA, INC
Entity Type:Organization
Organization Name:LIFECARE HOSPITALS OF NORTHERN NEVADA, INC
Other - Org Name:TAHOE PACIFIC HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF REIMBURSEMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRONIN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:469-241-2128
Mailing Address - Street 1:5340 LEGACY DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3178
Mailing Address - Country:US
Mailing Address - Phone:469-241-2100
Mailing Address - Fax:469-241-5198
Practice Address - Street 1:10101 DOUBLE R BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5931
Practice Address - Country:US
Practice Address - Phone:775-331-1044
Practice Address - Fax:775-326-6192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3878HOS-5282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100501884Medicaid
NV100501884Medicaid