Provider Demographics
NPI:1194100123
Name:SIERRA TREASURES INC
Entity type:Organization
Organization Name:SIERRA TREASURES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-826-7999
Mailing Address - Street 1:6490 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE C-19
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6165
Mailing Address - Country:US
Mailing Address - Phone:775-826-7999
Mailing Address - Fax:
Practice Address - Street 1:6490 S MCCARRAN BLVD
Practice Address - Street 2:SUITE C-19
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6165
Practice Address - Country:US
Practice Address - Phone:775-826-7999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5466PCS-5253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care