Provider Demographics
NPI:1316307648
Name:WANDA J ROSENLUND
Entity type:Organization
Organization Name:WANDA J ROSENLUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOST HOME PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSENLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-425-4585
Mailing Address - Street 1:2968 ALLARIZ CT
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-6446
Mailing Address - Country:US
Mailing Address - Phone:775-425-4585
Mailing Address - Fax:775-425-4585
Practice Address - Street 1:2968 ALLARIZ CT
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-6446
Practice Address - Country:US
Practice Address - Phone:775-425-4585
Practice Address - Fax:775-425-4585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-29
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV9005041577Medicaid