Healthcare Provider Details

I. General information

NPI: 1790019131
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF NEVADA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 SPECTRUM BLVD
LAS VEGAS NV
89101-4838
US

IV. Provider business mailing address

73 SPECTRUM BLVD
LAS VEGAS NV
89101-4838
US

V. Phone/Fax

Practice location:
  • Phone: 702-639-1730
  • Fax: 702-639-1736
Mailing address:
  • Phone: 702-639-1730
  • Fax: 702-639-1736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number5948PCS-4
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNV

VIII. Authorized Official

Name: MS. ARMENA MKHITARYAN
Title or Position: EXECUTIVE DIRECTOR
Credential: MPA
Phone: 702-639-1730