Provider Demographics
NPI:1730488644
Name:RENO SPARKS TRIBAL HEALTH CENTER
Entity Type:Organization
Organization Name:RENO SPARKS TRIBAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY HEALTH SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CORDELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEL-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PLN
Authorized Official - Phone:775-329-5162
Mailing Address - Street 1:1715 KUENZLI ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1117
Mailing Address - Country:US
Mailing Address - Phone:775-329-5162
Mailing Address - Fax:775-334-4357
Practice Address - Street 1:1715 KUENZLI ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1117
Practice Address - Country:US
Practice Address - Phone:775-329-5162
Practice Address - Fax:775-334-4357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLPN07194261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLPN07194Other164W00000X