Provider Demographics
NPI:1932261039
Name:TAHOE FOREST HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:TAHOE FOREST HOSPITAL DISTRICT
Other - Org Name:TAHOE FOREST SWING PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:BETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
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:530-587-6011
Mailing Address - Fax:530-582-3567
Practice Address - Street 1:10121 PINE AVE
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4835
Practice Address - Country:US
Practice Address - Phone:530-587-6011
Practice Address - Fax:530-582-3567
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAHOE FOREST HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-14
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA230000151275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05Z328Medicare Oscar/Certification