Provider Demographics
NPI:1336451491
Name:GREAT BASIN HOME HEALTH,LLC.
Entity type:Organization
Organization Name:GREAT BASIN HOME HEALTH,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:I
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-392-1188
Mailing Address - Street 1:1528 US HIGHWAY 395 N STE 245
Mailing Address - Street 2:
Mailing Address - City:GARDNERVILLE
Mailing Address - State:NV
Mailing Address - Zip Code:89410-5285
Mailing Address - Country:US
Mailing Address - Phone:775-392-1188
Mailing Address - Fax:775-392-1199
Practice Address - Street 1:1528 US HIGHWAY 395 N STE 245
Practice Address - Street 2:
Practice Address - City:GARDNERVILLE
Practice Address - State:NV
Practice Address - Zip Code:89410-5285
Practice Address - Country:US
Practice Address - Phone:775-392-1188
Practice Address - Fax:775-392-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20101453337251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health