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General NPI Number Information
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NPI Number | 1245418995
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Entity Type | Organization
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Legal Business Name | STATE OF NEVADA
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 05/21/2010
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Provider Practice Location Address
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Address Line | 480 GALLETTI WAY
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City | SPARKS
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State | NV
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Zip | 89431-5564
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Country | US
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Telephone | 775-688-2001
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Fax | 775-688-2004
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Provider Business Mailing Address
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Address Line | 480 GALLETTI WAY
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City | SPARKS
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State | NV
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Zip | 89431-5564
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Country | US
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Telephone | 775-688-2001
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Fax | 775-688-2004
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. ELIZABETH O'BRIEN
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Credential | CPA
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Telephone | 775-688-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 652HOS-14
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License Number State | NV
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