1619281276 NPI number — AMERICAN HOME COMPANION, INC.

Table of Contents

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 ; 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" .
  • 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" .

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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