JADE HOUSE MANAGED CARE NPI 1366005845

NPI Information

NPI: 1366005845
Provider Name: JADE HOUSE MANAGED CARE

Doing Business As: JADE HOUSE MANAGED CARE

Classification: Clinic/Center - 261QP2300X
Entity Type: Organization

Specialization: Primary Care

Address:
120 CORDERO ROAD
MCDERMITT, NV
ZIP 89421
Phone: (661) 301-3792
Get Directions

JADE HOUSE MANAGED CARE is a primary care clinic center in Mcdermitt, NV. JADE HOUSE MANAGED CARE NPI is 1366005845. The provider is registered as an organization entity type.
The provider Is Doing Business As Jade House Managed Care.

The provider's business location address is:

120 CORDERO ROAD
MCDERMITT, NV
ZIP 89421-344
Phone: (661) 301-3792
Fax: (775) 376-9983

The provider's authorized official is Bettina Giselle Alvarez .
The authorized official title is Owner and has the following contact phone number (775) 532-4366.

The CLIA number assigned to this NPI record is 29D2168275 - other practitioner with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/19/2019 and was last updated on 9/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP2300X	Clinic/Center	Primary Care			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100544708	MEDICAID	NEVADA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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