Provider Demographics
NPI:1669993572
Name:ST. PAUL'S HOME CARE III
Entity type:Organization
Organization Name:ST. PAUL'S HOME CARE III
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTEJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-657-6483
Mailing Address - Street 1:4910 KOENIG RD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-7811
Mailing Address - Country:US
Mailing Address - Phone:775-657-6483
Mailing Address - Fax:775-453-2263
Practice Address - Street 1:4910 KOENIG ROAD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89506-7811
Practice Address - Country:US
Practice Address - Phone:775-657-6483
Practice Address - Fax:775-453-2263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7195-AGC-6310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility