Provider Demographics
NPI:1801957667
Name:TAHOE FOREST HOSPITAL DISTRICT
Entity type:Organization
Organization Name:TAHOE FOREST HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:530-582-6656
Mailing Address - Street 1:10121 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4835
Mailing Address - Country:US
Mailing Address - Phone:530-582-3550
Mailing Address - Fax:530-582-3567
Practice Address - Street 1:880 ALDER AVE
Practice Address - Street 2:
Practice Address - City:INCLINE VILLAGE
Practice Address - State:NV
Practice Address - Zip Code:89451-8215
Practice Address - Country:US
Practice Address - Phone:775-832-3810
Practice Address - Fax:775-832-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV646HOS-12282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA051328Medicare Oscar/Certification
NV29-1301Medicare Oscar/Certification
CA555231Medicare Oscar/Certification