NPIMap

Organization Active NPI

Healthy Lifestyle Residence, LLC

  • Assisted Living Facility
  • Reno, NV
National Provider Identifier
1780903872
Registry record updated May 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
5880AGC-0 Issued in NV
Legal business name
HEALTHY LIFESTYLE RESIDENCE, LLC
Practice address
3990 Lakeside Dr
Reno, NV 89509-5336
Phone
(775) 828-5151
Fax
(775) 828-5152
NPI assigned
May 27, 2010
Last updated
May 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2010

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

Authorized official

Name
Ms. Felicisima A. Graham, RFA
Title
Administrator
Phone
(775) 828-5151

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 5880AGC-0 NV Primary

Addresses

Primary practice location

3990 Lakeside Dr
Reno, NV 89509-5336

Mailing address

3990 Lakeside Dr
Reno, NV 89509-5336
Phone (775) 828-5151

Other identifiers 1

IdentifierTypeStateIssuer
9005055957OtherNVATYPICAL PROVIDER IDENTIFIER NEVADA DIVISION OF HEALTHCARE FINANCING AND POLICY

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1274918400000",
    "number": "1780903872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3990 LAKESIDE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095336",
            "telephone_number": "775-828-5151",
            "fax_number": "775-828-5152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 LAKESIDE DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095336",
            "telephone_number": "775-828-5151",
            "fax_number": "775-828-5152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY LIFESTYLE RESIDENCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-27",
        "last_updated": "2010-05-27",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "FELICISIMA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "775-828-5151",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RFA"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NV",
            "license": "5880AGC-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ATYPICAL PROVIDER IDENTIFIER NEVADA DIVISION OF HEALTHCARE FINANCING AND POLICY",
            "identifier": "9005055957",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; 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.