Organization
HEALTHY LIFESTYLE RESIDENCE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. FELICISIMA A. GRAHAM RFA (ADMINISTRATOR)
(775) 828-5151
Entity
Organization
Contact information
Practice address
3990 LAKESIDE DR, RENO, NV 89509-5336
(775) 828-5151
(775) 828-5152
Mailing address
3990 LAKESIDE DR, RENO, NV 89509-5336
(775) 828-5151
(775) 828-5152
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
5880AGC-0
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9005055957
ATYPICAL PROVIDER IDENTIFIER NEVADA DIVISION OF HEALTHCARE FINANCING AND POLICY
NV
Enumeration date
05/27/2010
Last updated
05/27/2010
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