Wagoneer Group Care

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

Legal business name

WAGONEER GROUP CARE

Practice address

3705 Wagoneer Dr
Reno, NV 89502-5917

Phone

(775) 409-5675

Fax

(775) 800-1836

NPI assigned

Aug 19, 2016

Organization subpart

No

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

Authorized official

Name

Brenda Clarete Fink

Title

Owner Administrator

Phone

(775) 825-6876

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1471564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471564800000",
    "number": "1245785203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3705 WAGONEER DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895025917",
            "telephone_number": "775-409-5675",
            "fax_number": "775-800-1836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3705 WAGONEER DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895025917",
            "telephone_number": "775-409-5675",
            "fax_number": "775-800-1836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONEER GROUP CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-19",
        "last_updated": "2016-08-19",
        "status": "A",
        "authorized_official_last_name": "FINK",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "CLARETE",
        "authorized_official_title_or_position": "OWNER ADMINISTRATOR",
        "authorized_official_telephone_number": "775-825-6876"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "9005046915",
            "identifier": "9005046915",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carson Jewel Wagner
• Jessa Wagner
• Karen Wagner, APRN
• Kyle Matthew Wagner
• Marie Wagner, RBT
• Kristina S Wagoner
• Sara Wainwright, B.S.
• Tamika L Waiters, LSW
• Jamee N Wakefield
• Wal-Mart Stores Inc

• 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 Aug 19, 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.