Healthcare Provider Details

I. General information

NPI: 1598126443
Provider Name (Legal Business Name): NV ST DV MH/DS RURAL REGIONAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S 21ST ST
SPARKS NV
89431-8100
US

IV. Provider business mailing address

605 S 21ST ST
SPARKS NV
89431-8100
US

V. Phone/Fax

Practice location:
  • Phone: 775-688-1930
  • Fax:
Mailing address:
  • Phone: 775-688-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: KELLEY STEPRO
Title or Position: ACCOUNTING ASSISTANT IV
Credential:
Phone: 775-688-1930