Healthcare Provider Details

I. General information

NPI: 1811260094
Provider Name (Legal Business Name): NORTHERN NEVADA ADULT MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2012
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY
SPARKS NV
89431-5564
US

IV. Provider business mailing address

480 GALLETTI WAY
SPARKS NV
89431-5564
US

V. Phone/Fax

Practice location:
  • Phone: 775-688-2001
  • Fax: 775-688-2192
Mailing address:
  • Phone: 775-688-2001
  • Fax: 775-688-2192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number652
License Number StateNV

VIII. Authorized Official

Name: ELIZABETH O'BRIEN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 775-688-2001