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General NPI Number Information
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NPI Number | 1194410332
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Entity Type | Organization
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Legal Business Name | NEVADA SOUTHERN DETENTION CENTER
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Dates
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Enumeration Date | 04/05/2023
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 2190 E MESQUITE AVE
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City | PAHRUMP
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State | NV
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Zip | 89060-3427
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Country | US
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Telephone | 775-751-4500
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Fax |
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Provider Business Mailing Address
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Address Line | 1280 E CALVADA BLVD
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City | PAHRUMP
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State | NV
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Zip | 89048-5693
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Country | US
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Telephone | 928-201-2035
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHELLEY RENEE THOMPSON
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Credential | NP
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Telephone | 928-201-2035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number |
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License Number State |
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