Provider Demographics
NPI:1952757601
Name:GOOD OLD DAYS HOME CARE LLC
Entity Type:Organization
Organization Name:GOOD OLD DAYS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIETMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:INGENSIEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-315-9503
Mailing Address - Street 1:2255 WIDE HORIZON DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5078
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5855 LONE HORSE DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-9010
Practice Address - Country:US
Practice Address - Phone:775-315-9503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8101AGC-2311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLICENSE NUMBEROther8101AGC-2