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General NPI Number Information
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NPI Number | 1306338215
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Entity Type | Organization
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Legal Business Name | DOUGLAS CO AND UNINCORPORATED TOWNS
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 225 CHINA SPRING RD
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City | GARDNERVILLE
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State | NV
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Zip | 89410
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Country | US
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Telephone | 775-265-5350
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 218
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City | MINDEN
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State | NV
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Zip | 89423-0218
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Country | US
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Telephone | 775-265-5350
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Fax | 775-265-7159
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Authorized Official
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Title or Position | DIRECTOR OF JUVENILE CAMP SERVICES
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Name | MRS. WENDY COLLEEN GARRISON
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Credential |
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Telephone | 775-265-5350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 8954-PRTF-0
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License Number State | NV
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