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General NPI Number Information
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NPI Number | 1417582230
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Entity Type | Organization
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Legal Business Name | STATE OF NEVADA - PRTF NORTH
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Dates
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Enumeration Date | 03/12/2020
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 480 GALLETTI WAY BLDG 8N
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City | SPARKS
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State | NV
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Zip | 89431
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Country | US
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Telephone | 775-688-1633
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Fax | 775-688-1640
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Provider Business Mailing Address
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Address Line | 500 E WARM SPRINGS RD
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City | LAS VEGAS
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State | NV
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Zip | 89119-4344
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Country | US
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Telephone | 702-486-8226
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Fax | 702-466-6057
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Authorized Official
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Title or Position | MANAGEMENT ANALYST 4
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Name | SANDRA STONE
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Credential |
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Telephone | 702-486-8226
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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 |
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License Number State |
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