Provider Demographics
NPI:1104286517
Name:TANNERWOOD HOME LLC
Entity type:Organization
Organization Name:TANNERWOOD HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FAHNESTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-771-2117
Mailing Address - Street 1:5505 TANNERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-5021
Mailing Address - Country:US
Mailing Address - Phone:775-771-2117
Mailing Address - Fax:
Practice Address - Street 1:5505 TANNERWOOD DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-5021
Practice Address - Country:US
Practice Address - Phone:775-771-2117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005054802Medicaid