Provider Demographics
NPI:1104136993
Name:ST. PAUL HOMECARE 1
Entity type:Organization
Organization Name:ST. PAUL HOMECARE 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:BELTEJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-337-6900
Mailing Address - Street 1:1500 MANHATTAN ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512
Mailing Address - Country:US
Mailing Address - Phone:775-337-6900
Mailing Address - Fax:775-337-6900
Practice Address - Street 1:1500 MANHATTAN ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512
Practice Address - Country:US
Practice Address - Phone:775-337-6900
Practice Address - Fax:775-337-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2010AGC-15310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility