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General NPI Number Information
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NPI Number | 1487832085
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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 | 02/06/2008
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Last Update Date | 10/20/2015
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Provider Practice Location Address
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Address Line | 1528 US HIGHWAY 395 N SUITE 100
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City | GARDNERVILLE
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State | NV
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Zip | 89410-5265
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Country | US
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Telephone | 775-782-3671
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Fax | 775-782-6639
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Provider Business Mailing Address
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Address Line | 727 FAIRVIEW DR SUITE A
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City | CARSON CITY
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State | NV
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Zip | 89701-5795
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Country | US
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Telephone | 775-687-5018
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Fax | 775-687-1181
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Authorized Official
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Title or Position | BILLING SUPERVISOR
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Name | SIRI MCMILLIN
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Credential |
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Telephone | 775-684-5018
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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 |
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License Number State |
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