Provider Demographics
NPI:1134525587
Name:UNLIMITED POSSIBILITIES OR RENO, LLC
Entity type:Organization
Organization Name:UNLIMITED POSSIBILITIES OR RENO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-467-1377
Mailing Address - Street 1:PO BOX 370724
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137-0724
Mailing Address - Country:US
Mailing Address - Phone:702-467-1377
Mailing Address - Fax:702-823-4781
Practice Address - Street 1:1 E LIBERTY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-2110
Practice Address - Country:US
Practice Address - Phone:702-467-1377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20141663904320900000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========Medicaid