Provider Demographics
NPI:1780579292
Name:CARESOURCE NEVADA CO.
Entity type:Organization
Organization Name:CARESOURCE NEVADA CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:
Authorized Official - Last Name:PUU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-974-3518
Mailing Address - Street 1:230 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-1263
Mailing Address - Country:US
Mailing Address - Phone:937-224-3000
Mailing Address - Fax:
Practice Address - Street 1:2850 W HORIZON RIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4395
Practice Address - Country:US
Practice Address - Phone:725-332-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARESOURCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization