=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811496607
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEVADA HEALTH CENTERS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2018
-----------------------------------------------------
Last Update Date | 04/04/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 PALO VERDE DR
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89015-6028
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-636-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3325 RESEARCH WAY
-----------------------------------------------------
City | CARSON CITY
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89706-7913
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-888-6610
-----------------------------------------------------
Fax | 775-888-4904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER RELATIONS MANAGER
-----------------------------------------------------
Name | PATRICIA SCHROEDER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 775-888-6610
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number | 29D2143403
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------