Healthcare Provider Details

I. General information

NPI: 1316142623
Provider Name (Legal Business Name): NEVADA FAMILY PRACTICE RESIDENCY PROGRAM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W MOANA LN SUITE 100
RENO NV
89509-4932
US

IV. Provider business mailing address

745 W MOANA LN SUITE 100
RENO NV
89509-4932
US

V. Phone/Fax

Practice location:
  • Phone: 775-334-3033
  • Fax: 775-334-3022
Mailing address:
  • Phone: 775-334-3033
  • Fax: 775-334-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNV

VIII. Authorized Official

Name: JAMES R PARCELLS
Title or Position: PRESIDENT
Credential: LISW
Phone: 702-968-5059