Provider Demographics
NPI:1003375437
Name:OUR HOME ADULT LIVING
Entity type:Organization
Organization Name:OUR HOME ADULT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:ALIX
Authorized Official - Last Name:SAPICO
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:775-843-7413
Mailing Address - Street 1:4180 SIERRA MADRE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-6328
Mailing Address - Country:US
Mailing Address - Phone:775-827-1619
Mailing Address - Fax:775-827-8512
Practice Address - Street 1:4180 SIERRA MADRE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6328
Practice Address - Country:US
Practice Address - Phone:775-827-1619
Practice Address - Fax:775-827-8512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005055577Medicaid