Provider Demographics
NPI:1497028716
Name:THE GATLIN SPIRIT HOUSE
Entity Type:Organization
Organization Name:THE GATLIN SPIRIT HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GATLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-221-1846
Mailing Address - Street 1:5985 OMAHA ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506
Mailing Address - Country:UM
Mailing Address - Phone:775-221-1846
Mailing Address - Fax:
Practice Address - Street 1:5985 OMAHA ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-8812
Practice Address - Country:US
Practice Address - Phone:775-221-1846
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVC201111070579253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care