Provider Demographics
NPI:1194039339
Name:AMERICAN HOME COMPANION, INC.
Entity type:Organization
Organization Name:AMERICAN HOME COMPANION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:MIGUEL
Authorized Official - Last Name:MONTERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-826-8090
Mailing Address - Street 1:3708 LAKESIDE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5238
Mailing Address - Country:US
Mailing Address - Phone:775-826-8090
Mailing Address - Fax:775-826-9008
Practice Address - Street 1:307 W WINNIE LN
Practice Address - Street 2:SUITE# 6
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-2103
Practice Address - Country:US
Practice Address - Phone:775-883-8840
Practice Address - Fax:775-883-8820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7525HHA-0251E00000X
NVNV19991331652253Z00000X, 332B00000X, 332BX2000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003016623Medicaid
NV1235230418OtherNATIONAL PROVIDER ID FOR ADDITIONAL SERVICE LOCATION
NV9005048036OtherATYPICAL PROVIDER ID
NV9005048069OtherATYPICAL PROVIDER ID
NV005814623Medicaid
NV9005048044OtherATYPICAL PROVIDER ID
IDM8081285-000Medicaid
NV100500261Medicaid
NV100500587Medicaid
NV9005051162OtherATYPICAL PROVIDER ID
NV003016623Medicaid