Healthcare Provider Details

I. General information

NPI: 1053557900
Provider Name (Legal Business Name): SOUTHERN NEVADA ADULT MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COMMUNITY COLLEGE DRIVE
LAS VEGAS NV
89146
US

IV. Provider business mailing address

6161 WEST CHARLESTON
LAS VEGAS NV
89146-1126
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-6570
  • Fax: 702-486-8330
Mailing address:
  • Phone: 702-486-6570
  • Fax: 702-486-8330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number1B00759
License Number StateNV

VIII. Authorized Official

Name: DR. EMMANUEL C. EBO
Title or Position: STATEWIDE PHARMACY DIRECTOR
Credential: PHARM.D.
Phone: 702-486-6570