Healthcare Provider Details

I. General information

NPI: 1518764091
Provider Name (Legal Business Name): CITY OF LAS VEGAS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N CASINO CENTER BLVD
LAS VEGAS NV
89101-2944
US

IV. Provider business mailing address

PO BOX 748029
LOS ANGELES CA
90074-8029
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2888
  • Fax:
Mailing address:
  • Phone: 914-432-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: HEATHER THANEPOHN
Title or Position: CRT PROGRAM MANAGER
Credential:
Phone: 702-762-3188