Provider Demographics
NPI:1356348890
Name:BARTON HEALTHCARE SYSTEM
Entity type:Organization
Organization Name:BARTON HEALTHCARE SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:PURVANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-541-3420
Mailing Address - Street 1:2092 LAKE TAHOE BLVD
Mailing Address - Street 2:#500
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6422
Mailing Address - Country:US
Mailing Address - Phone:530-543-5581
Mailing Address - Fax:530-541-2653
Practice Address - Street 1:2092 LAKE TAHOE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6429
Practice Address - Country:US
Practice Address - Phone:530-543-5581
Practice Address - Fax:530-541-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1985HHA-13251E00000X
CA100000174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA057226Medicare Oscar/Certification
CA057226Medicare Oscar/Certification
NV002903004Medicaid