Provider Demographics
NPI:1205078391
Name:CATHOLIC HEALTHCARE WEST
Entity type:Organization
Organization Name:CATHOLIC HEALTHCARE WEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:EARLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-770-3591
Mailing Address - Street 1:6770 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE102
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6176
Mailing Address - Country:US
Mailing Address - Phone:775-770-3591
Mailing Address - Fax:775-770-6110
Practice Address - Street 1:6770 S MCCARRAN BLVD
Practice Address - Street 2:SUITE102
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6176
Practice Address - Country:US
Practice Address - Phone:775-770-3591
Practice Address - Fax:775-770-6110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3291124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty