Provider Demographics
NPI:1538174123
Name:TAHOE FOREST HOSPITAL DISTRICT
Entity type:Organization
Organization Name:TAHOE FOREST HOSPITAL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BILJANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILICEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-587-7607
Mailing Address - Street 1:10956 DONNER PASS RD
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4861
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10956 DONNER PASS RD
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4861
Practice Address - Country:US
Practice Address - Phone:530-587-7607
Practice Address - Fax:530-587-6771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAHOE FOREST HOSPITAL DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X, 3336C0003X
CAPHY41861333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0589842OtherOTHER ID NUMBER-COMMERCIAL NUMBER