Mar Von Senior Care

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

285AGC12 Issued in NV

Legal business name

MAR VON SENIOR CARE

Practice address

300 La Rue Ave
Reno, NV 89509-2014

Phone

(775) 323-4696

Fax

(775) 626-4605

NPI assigned

Jan 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Theresa Cruz Basallo, RN

Title

Administrator

Phone

(775) 323-4696

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455580800000",
    "number": "1104974500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4816 CRESTSIDE DR",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894363667",
            "telephone_number": "775-323-4696",
            "fax_number": "775-626-4605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LA RUE AVE",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895092014",
            "telephone_number": "775-323-4696",
            "fax_number": "775-626-4605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAR VON SENIOR CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2016-02-16",
        "status": "A",
        "authorized_official_last_name": "BASALLO",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "CRUZ",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "775-323-4696",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "NV",
            "license": "285AGC12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005716019",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Maple Star Nevada
• Maple Star Nevada
• Maple Star Nevada
• Maple Star Nevada
• Maple Star Nevada LLC
• David Mar, M.D.
• Gabrielle Marangi
• Josephina Marie Marangi
• Jaimee Therese Maranon, MS, NDTR
• Jade Lynn Marasco-Wetzel

• Adult Care Home Facility in Reno, NV
• Providers in Reno, NV by specialty
• Adult Care Home Facility in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.