MEDICARE: STATE OF NEVADA - DWTC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	323P00000X	Psychiatric Residential Treatment Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811953003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE OF NEVADA - DWTC

Provider Business Mailing Address
First Line	:	500 E WARM SPRINGS RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4344
Country	:	US
Telephone Number	:	702-486-8226
Fax Number	:	702-486-6057

Provider Business Practice Location Address
First Line	:	6171 W CHARLESTON BLVD BLDG 17
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1126
Country	:	US
Telephone Number	:	702-486-6100
Fax Number	:	702-486-6057

Authorized Official
Title or Position	:	MANAGEMENT ANALYST 4
Name	:	SANDRA STONE
Credential	:
Telephone Number	:	702-486-8226

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	02/13/2025

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Directions to “STATE OF NEVADA - DWTC ” Practice Location

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