Healthcare Provider Details

I. General information

NPI: 1275600629
Provider Name (Legal Business Name): STATE OF NEVADA - DWTC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6171 W CHARLESTON BLVD BLDG 17
LAS VEGAS NV
89146-1126
US

IV. Provider business mailing address

500 E WARM SPRINGS RD
LAS VEGAS NV
89119-4344
US

V. Phone/Fax

Practice location:
  • Phone: 702-486-8900
  • Fax: 702-486-6307
Mailing address:
  • Phone: 702-486-8226
  • Fax: 702-486-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: SANDRA STONE
Title or Position: MANAGEMENT ANALYST 4
Credential:
Phone: 702-486-8226