{
"Npi": {
"NPI": "1275600629",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "STATE OF NEVADA - DWTC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "500 E WARM SPRINGS RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89119-4344",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-486-8226",
"MailingAddressFaxNumber": "702-486-6057",
"FirstLinePracticeLocationAddress": "6171 W CHARLESTON BLVD BLDG 17",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89146-1126",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-486-8900",
"PracticeLocationAddressFaxNumber": "702-486-6307",
"EnumerationDate": "11/29/2006",
"LastUpdateDate": "02/13/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "STONE",
"AuthorizedOfficialFirstName": "SANDRA",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "MANAGEMENT ANALYST 4",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "702-486-8226",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "283Q00000X",
"TaxonomyName": "Psychiatric Hospital",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}