Healthcare Provider Details

I. General information

NPI: 1154555019
Provider Name (Legal Business Name): ATKINSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2281 AULTMAN ST
ELY NV
89301-1831
US

IV. Provider business mailing address

PO BOX 1287
MC GILL NV
89318-1287
US

V. Phone/Fax

Practice location:
  • Phone: 775-296-1583
  • Fax:
Mailing address:
  • Phone: 775-591-0307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPY0499
License Number StateNV

VIII. Authorized Official

Name: MR. OSKAR L ATKINSON
Title or Position: MANAGER
Credential:
Phone: 775-591-0307