Provider Demographics
NPI:1689139610
Name:CESSABELLA RESIDENTIAL SUITE LLC
Entity Type:Organization
Organization Name:CESSABELLA RESIDENTIAL SUITE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:AIHLA
Authorized Official - Last Name:JALANDONI SIGUA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-250-0767
Mailing Address - Street 1:480 S WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1823
Mailing Address - Country:US
Mailing Address - Phone:775-351-8470
Mailing Address - Fax:888-618-1758
Practice Address - Street 1:8295 OPAL STATION DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-7781
Practice Address - Country:US
Practice Address - Phone:775-677-9760
Practice Address - Fax:888-618-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005055429Medicaid