Healthcare Provider Details

I. General information

NPI: 1982985636
Provider Name (Legal Business Name): BRIARWOOD TREATMENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2011
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY # 8C
SPARKS NV
89431-5564
US

IV. Provider business mailing address

480 GALLETTI WAY # 8C
SPARKS NV
89431-5564
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-1490
  • Fax:
Mailing address:
  • Phone: 775-324-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. NOELLE ANN GRAVALLESE
Title or Position: MENTAL HEALTH TECH
Credential:
Phone: 775-240-2515