1619281276 NPI number — AMERICAN HOME COMPANION, INC.

Table of content: (NPI 1619281276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619281276 NPI number — AMERICAN HOME COMPANION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN HOME COMPANION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619281276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3708 LAKESIDE DR
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89509-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-826-8090
Provider Business Mailing Address Fax Number:
775-826-9008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 IDAHO ST
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
ELKO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89801-3765
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-778-9960
Provider Business Practice Location Address Fax Number:
775-778-9962
Provider Enumeration Date:
08/05/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MONTERO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
MIGUEL
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
775-826-8090

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7525HHA-0 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: NV19991331652 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: NV19991331652 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: NV19991331652 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1235230418 . This is a "NATIONAL PROVIDER ID FOR ADDITIONAL SERVICE LOCATION" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 9005048036 . This is a "ATYPICAL PROVIDER ID" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 9005048044 . This is a "ATYPICAL PROVIDER ID" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 005814623 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100500261 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100500587 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9005051162 . This is a "ATYPICAL PROVIDER ID" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 9005048069 . This is a "ATYPICAL PROVIDER ID" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: M8081285-000 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003016623 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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